Provider Demographics
NPI:1922707389
Name:APPEL, GRACE GOLLIDAY (COTA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:GOLLIDAY
Last Name:APPEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:GOLLIDAY
Other - Last Name:PRETORIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464-625 DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96114-8600
Mailing Address - Country:US
Mailing Address - Phone:909-557-8978
Mailing Address - Fax:
Practice Address - Street 1:2005 RIVER ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4524
Practice Address - Country:US
Practice Address - Phone:530-257-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3224224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant