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NPI Code Detail

MEDICARE: TIA GRANT OTR/L

MEDICARE: TIA GRANT OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NAOTHERN/A

General Provider Information

NPI Number : 1396492740
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA GRANT OTR/L
Provider Business Mailing Address
First Line : 5800 PURPLE HAZE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4581
Country : US
Telephone Number : 217-725-4148
Fax Number :
Provider Business Practice Location Address
First Line : 9079 W POST RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2414
Country : US
Telephone Number : 833-759-8720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2022
Last Update Date : 09/15/2025

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Directions to “ TIA GRANT OTR/L” Practice Location

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