Provider Demographics
NPI:1427559863
Name:GRANADA, CHERYL MAE LOZANO (OTD, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CHERYL MAE
Middle Name:LOZANO
Last Name:GRANADA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 PARK GREEN PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1995
Mailing Address - Country:US
Mailing Address - Phone:352-693-1202
Mailing Address - Fax:
Practice Address - Street 1:301 S TUBB ST STE A1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-8859
Practice Address - Country:US
Practice Address - Phone:407-395-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist