Provider Demographics
NPI:1629506431
Name:GRAVES, LISA MARIAH (OTD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIAH
Last Name:GRAVES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIAH
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD
Mailing Address - Street 1:2390 HOLLAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-2642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1503 MICHAELS RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4822
Practice Address - Country:US
Practice Address - Phone:336-509-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist