Provider Demographics
NPI:1720299613
Name:LIM, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E 3RD AVE
Mailing Address - Street 2:#2205
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2166
Mailing Address - Country:US
Mailing Address - Phone:310-433-5990
Mailing Address - Fax:
Practice Address - Street 1:1600 E 3RD AVE
Practice Address - Street 2:#2205
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2166
Practice Address - Country:US
Practice Address - Phone:310-433-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist