Provider Demographics
NPI:1366676215
Name:GRANT, CHRISTOPER MICHAEL (OTR)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPER
Middle Name:MICHAEL
Last Name:GRANT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SKI BOWL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12853-2607
Mailing Address - Country:US
Mailing Address - Phone:518-251-2447
Mailing Address - Fax:
Practice Address - Street 1:112 SKI BOWL RD
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853-2607
Practice Address - Country:US
Practice Address - Phone:518-251-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0172241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist