Provider Demographics
NPI:1013167584
Name:GRATTON, REBECCA GRACE (OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRACE
Last Name:GRATTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GRACE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 N ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2629
Mailing Address - Country:US
Mailing Address - Phone:864-331-1353
Mailing Address - Fax:864-331-1446
Practice Address - Street 1:29 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:864-331-1353
Practice Address - Fax:864-331-1446
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4114225X00000X
SC3454225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4254015OtherBLUE CROSS BLUE SHIELD OF TN
TNCH4394OtherMEDICARE RAILROAD GROUP
TN4254015OtherBLUE CROSS BLUE SHIELD OF TN