Provider Demographics
NPI:1609110154
Name:GRAHAM, PATRICIA S (COTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:S
Other - Last Name:GRAHAM-JOYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3502 E 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-1542
Mailing Address - Country:US
Mailing Address - Phone:256-383-8805
Mailing Address - Fax:
Practice Address - Street 1:813 KELLER LN
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1110
Practice Address - Country:US
Practice Address - Phone:256-383-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0409224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant