Provider Demographics
NPI:1407173222
Name:GRANT, WELTHA JANE (PHD, OTR/L, CHT)
Entity Type:Individual
Prefix:DR
First Name:WELTHA
Middle Name:JANE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4604
Mailing Address - Country:US
Mailing Address - Phone:610-353-6969
Mailing Address - Fax:610-353-2972
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:1ST FLOOR, REAR
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1727
Practice Address - Country:US
Practice Address - Phone:484-433-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003841L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist