Provider Demographics
NPI:1407037591
Name:GRAHAM, BARBARA LEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LEE
Last Name:GRAHAM
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 1:611 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2856
Mailing Address - Country:US
Mailing Address - Phone:803-531-4368
Mailing Address - Fax:
Practice Address - Street 1:611 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2856
Practice Address - Country:US
Practice Address - Phone:803-531-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist