Provider Demographics
NPI:1043522691
Name:GRAJALES, GLORIA MARCELA (OTR)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARCELA
Last Name:GRAJALES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 NE 22ND CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5134
Mailing Address - Country:US
Mailing Address - Phone:305-333-0284
Mailing Address - Fax:800-281-0545
Practice Address - Street 1:8955 SW 87TH CT
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2230
Practice Address - Country:US
Practice Address - Phone:786-363-3900
Practice Address - Fax:305-630-9654
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist