Provider Demographics
NPI:1477703643
Name:GRAH, NANCY J (COTA)
Entity type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:J
Last Name:GRAH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16729 KENMOR RD
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:KENDALL
Mailing Address - State:NY
Mailing Address - Zip Code:14476-0338
Mailing Address - Country:US
Mailing Address - Phone:585-659-8439
Mailing Address - Fax:
Practice Address - Street 1:16729 KENMOR ROAD
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:NY
Practice Address - Zip Code:14476-0338
Practice Address - Country:US
Practice Address - Phone:585-659-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000808-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant