Provider Demographics
NPI:1790509362
Name:O'GRADY, TY DANIEL (OTD)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:DANIEL
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S CARROLL BLVD APT 256
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-0001
Mailing Address - Country:US
Mailing Address - Phone:254-495-3400
Mailing Address - Fax:
Practice Address - Street 1:1000 W CROSBY RD STE 136
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6904
Practice Address - Country:US
Practice Address - Phone:972-237-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124965225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics