Provider Demographics
NPI:1518280882
Name:GRANTHAM, REBECCA L (OT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6213
Mailing Address - Country:US
Mailing Address - Phone:601-317-1041
Mailing Address - Fax:
Practice Address - Street 1:1000 VETERAN AVE
Practice Address - Street 2:SUITE A-744
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8974
Practice Address - Country:US
Practice Address - Phone:323-794-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2334225X00000X
CA11832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist