Provider Demographics
NPI:1295157857
Name:JEFFORDS, ERIN GRAVINO (OTR/L, MS)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:GRAVINO
Last Name:JEFFORDS
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:GRAVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, MS
Mailing Address - Street 1:731 POLO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:731 POLO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4462
Practice Address - Country:US
Practice Address - Phone:803-351-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005879225X00000X
SC3590225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist