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NPI Code Detail

MEDICARE: MRS. CHARMAINE QUIRANTE GRUMO OTR/L

MEDICARE: MRS. CHARMAINE QUIRANTE GRUMO 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 Therapist0834NV

General Provider Information

NPI Number : 1649438607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARMAINE QUIRANTE GRUMO OTR/L
Provider Business Mailing Address
First Line : 4501 N BLAGG RD
Second Line :
City : PAHRUMP
State : NV
Zip : 89060-1946
Country : US
Telephone Number : 775-751-8664
Fax Number : 775-751-1978
Provider Business Practice Location Address
First Line : 4501 N BLAGG RD
Second Line :
City : PAHRUMP
State : NV
Zip : 89060-1946
Country : US
Telephone Number : 775-751-8664
Fax Number : 775-751-1978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2008
Last Update Date : 05/27/2008

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