Provider Demographics
NPI:1679628986
Name:GRANDE, ROBIN (OT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:GRANDE
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 1:116 HOLIDAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3011
Mailing Address - Country:US
Mailing Address - Phone:631-878-6928
Mailing Address - Fax:
Practice Address - Street 1:116 HOLIDAY BLVD
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3011
Practice Address - Country:US
Practice Address - Phone:631-878-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist