Provider Demographics
NPI:1164542981
Name:GRAHAM, MARY HELEN (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HELEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:MRS
Other - First Name:MICI
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR, CHT
Mailing Address - Street 1:1617 COUNTY ROAD 159
Mailing Address - Street 2:
Mailing Address - City:OVALO
Mailing Address - State:TX
Mailing Address - Zip Code:79541-3203
Mailing Address - Country:US
Mailing Address - Phone:325-665-2667
Mailing Address - Fax:325-583-2821
Practice Address - Street 1:4601 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4603
Practice Address - Country:US
Practice Address - Phone:325-793-3400
Practice Address - Fax:325-793-3585
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist