Provider Demographics
NPI:1821401829
Name:GRAVES, APRIL L (COTA/L)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:L
Last Name:GRAVES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REAR FREESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1817
Mailing Address - Country:US
Mailing Address - Phone:860-372-1159
Mailing Address - Fax:
Practice Address - Street 1:36 FIRETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1965
Practice Address - Country:US
Practice Address - Phone:860-658-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1487224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant