Provider Demographics
NPI:1477040004
Name:STANFORD, GRACE POWELL (OTR/L)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:POWELL
Last Name:STANFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ELIZABETH
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2922
Mailing Address - Country:US
Mailing Address - Phone:931-510-8384
Mailing Address - Fax:
Practice Address - Street 1:1400 MCCALLIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2927
Practice Address - Country:US
Practice Address - Phone:931-510-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics