Provider Demographics
NPI:1841843737
Name:THAO, GRACE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:THAO
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 1:3458 BUNKER HILL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28610-9669
Mailing Address - Country:US
Mailing Address - Phone:828-202-9659
Mailing Address - Fax:
Practice Address - Street 1:3458 BUNKER HILL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NC
Practice Address - Zip Code:28610-9669
Practice Address - Country:US
Practice Address - Phone:828-202-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10956225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics