Provider Demographics
NPI:1841538428
Name:GRAJEDA, AUDRA JO (OTR)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:JO
Last Name:GRAJEDA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 DOE RUN LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-2832
Mailing Address - Country:US
Mailing Address - Phone:970-310-9422
Mailing Address - Fax:
Practice Address - Street 1:949 DOE RUN LN
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2832
Practice Address - Country:US
Practice Address - Phone:970-310-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003574171W00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor