Provider Demographics
NPI:1295573400
Name:GRAMM, GRAYCIE PAIGE (OTAS)
Entity type:Individual
Prefix:
First Name:GRAYCIE
Middle Name:PAIGE
Last Name:GRAMM
Suffix:
Gender:F
Credentials:OTAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17784 S HIGHWAY 48
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2119
Mailing Address - Country:US
Mailing Address - Phone:918-998-4902
Mailing Address - Fax:
Practice Address - Street 1:14002 E 21ST ST STE 650
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1432
Practice Address - Country:US
Practice Address - Phone:918-274-7902
Practice Address - Fax:918-512-2120
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2666224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant