Basic Information
| Provider Information | |||||||||
| NPI: | 1447563614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIGSBY | ||||||||
| FirstName: | RANDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2108 OXFORD AVE APT 4 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45230 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2217 WEST AVE | ||||||||
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| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440043107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409648446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2010 | ||||||||
| LastUpdateDate: | 07/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XG0600X | 000007 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 225XM0800X | 000007 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health |
No ID Information.