Provider Demographics
NPI:1134437858
Name:GRAVA, CHERYL LYNN (OT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:GRAVA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:10293 DIXIE HWY
Mailing Address - Street 2:SUITE O
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9210
Mailing Address - Country:US
Mailing Address - Phone:810-771-7685
Mailing Address - Fax:810-771-7686
Practice Address - Street 1:10293 DIXIE HWY
Practice Address - Street 2:SUITE O
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9210
Practice Address - Country:US
Practice Address - Phone:810-771-7685
Practice Address - Fax:810-771-7686
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist