Provider Demographics
NPI:1740468412
Name:GRANDE, CAROL THERESA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:THERESA
Last Name:GRANDE
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 1:2600 CARTER GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3402
Mailing Address - Country:US
Mailing Address - Phone:407-909-1396
Mailing Address - Fax:407-909-9021
Practice Address - Street 1:2600 CARTER GROVE CIR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3402
Practice Address - Country:US
Practice Address - Phone:407-909-1396
Practice Address - Fax:407-909-9021
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist