Provider Demographics
NPI:1952299695
Name:SPANOS, GRACE A (OT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:SPANOS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:A
Other - Last Name:SPANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4141 31ST AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8778
Mailing Address - Country:US
Mailing Address - Phone:701-353-1488
Mailing Address - Fax:213-867-2798
Practice Address - Street 1:4141 31ST AVE S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8778
Practice Address - Country:US
Practice Address - Phone:701-353-1488
Practice Address - Fax:213-867-2798
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106707225X00000X
ND1879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist