MEDICARE: MRS. ADRIANE GRILL RANSOM M.A, 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
1	225XP0200X	Pediatric Occupational Therapist	1491	CA

General Provider Information

NPI Number	:	1932263019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIANE GRILL RANSOM M.A, OTR-L

Provider Business Mailing Address
First Line	:	1523 WELLESLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3629
Country	:	US
Telephone Number	:	310-529-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 WELLESLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3629
Country	:	US
Telephone Number	:	310-529-2411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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