Provider Demographics
NPI:1639651904
Name:GRANADOS, ARTURO JR (COTA)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:
Last Name:GRANADOS
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 LUNA RD APT 16105
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6298
Mailing Address - Country:US
Mailing Address - Phone:214-984-9366
Mailing Address - Fax:
Practice Address - Street 1:8383 MEADOW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3701
Practice Address - Country:US
Practice Address - Phone:214-239-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212117224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant