Provider Demographics
NPI:1326525593
Name:GRAJEDA, ANTONIA ELENI (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:ELENI
Last Name:GRAJEDA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:ELENI
Other - Last Name:STAVRIANOUDAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:534 E PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:534 E PINE ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5536
Practice Address - Country:US
Practice Address - Phone:209-463-5800
Practice Address - Fax:209-463-5900
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist