Basic Information
| Provider Information | |||||||||
| NPI: | 1760732366 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GRATE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 203 | ||||||||
| Address2: | 7827 MAIN STREET | ||||||||
| City: | OLD FORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193079331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 N HURSTBORNE PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024125847 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA.04203 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.