Provider Demographics
NPI:1245554906
Name:GRANDINETTI, MARIE (OT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GRANDINETTI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 KEARNY VILLA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1951
Mailing Address - Country:US
Mailing Address - Phone:858-505-5460
Mailing Address - Fax:
Practice Address - Street 1:3666 KEARNY VILLA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1951
Practice Address - Country:US
Practice Address - Phone:858-505-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist