Provider Demographics
NPI:1912278532
Name:GRANTZ, PAMELA S (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:GRANTZ
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 1:21419 E FOX DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73730-2015
Mailing Address - Country:US
Mailing Address - Phone:580-864-7475
Mailing Address - Fax:
Practice Address - Street 1:305 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5832
Practice Address - Country:US
Practice Address - Phone:580-233-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK793225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist