Provider Demographics
NPI:1427619543
Name:GRAYBEAL, FELICIA (OT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:LYNN
Other - Last Name:HAMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:813-381-4944
Mailing Address - Fax:
Practice Address - Street 1:1804 OAKLEY SEAVER DR STE E
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:813-381-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR420874225X00000X, 225XH1200X
FLOT20073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR420874OtherOR OT LICENSE
OR500786931Medicaid