Provider Demographics
NPI:1437364437
Name:ISAAC, GRACY GEORGE (OT)
Entity Type:Individual
Prefix:MRS
First Name:GRACY
Middle Name:GEORGE
Last Name:ISAAC
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GRACY
Other - Middle Name:GEORGE
Other - Last Name:PARAYIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8613 NW 69TH CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6905 W WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5494
Practice Address - Country:US
Practice Address - Phone:405-445-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK611225X00000X
OKOT611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist