Provider Demographics
NPI:1366866360
Name:GRANT, CHRISTY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2521
Mailing Address - Country:US
Mailing Address - Phone:850-769-5371
Mailing Address - Fax:850-872-9558
Practice Address - Street 1:927 GRACE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2521
Practice Address - Country:US
Practice Address - Phone:850-769-5371
Practice Address - Fax:850-872-9558
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010604200Medicaid