Provider Demographics
NPI:1275118853
Name:GRANADOS MOLINA, JOSE ALEXI (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEXI
Last Name:GRANADOS MOLINA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 MIDTOWN AVE APT 1517
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1440
Mailing Address - Country:US
Mailing Address - Phone:719-557-9453
Mailing Address - Fax:
Practice Address - Street 1:7116 FORT HUNT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1900
Practice Address - Country:US
Practice Address - Phone:703-768-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131-002464224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant