Provider Demographics
NPI:1629406459
Name:GRIMALDI, ALLISON MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4781
Mailing Address - Country:US
Mailing Address - Phone:716-432-7166
Mailing Address - Fax:
Practice Address - Street 1:2092 AYRSLEY TOWN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4037
Practice Address - Country:US
Practice Address - Phone:704-577-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017851-1174400000X
NC11090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist