Provider Demographics
NPI:1992031561
Name:GRAHAM, RICHARD DWIGHT (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DWIGHT
Last Name:GRAHAM
Suffix:
Gender:M
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 1:3270 LYNN RIDGE DR APT 2E
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8921
Mailing Address - Country:US
Mailing Address - Phone:828-507-3424
Mailing Address - Fax:
Practice Address - Street 1:3270 LYNN RIDGE DR APT 2E
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-8921
Practice Address - Country:US
Practice Address - Phone:828-507-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5993224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant