Provider Demographics
NPI:1649438607
Name:GRUMO, CHARMAINE QUIRANTE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:QUIRANTE
Last Name:GRUMO
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 1:4501 N BLAGG RD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-1946
Mailing Address - Country:US
Mailing Address - Phone:775-751-8664
Mailing Address - Fax:775-751-1978
Practice Address - Street 1:4501 N BLAGG RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-1946
Practice Address - Country:US
Practice Address - Phone:775-751-8664
Practice Address - Fax:775-751-1978
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist