Provider Demographics
NPI:1952988438
Name:GRIFFIN, EZEKIEL J (OT/L)
Entity Type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8648 OLD SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6610
Mailing Address - Country:US
Mailing Address - Phone:205-249-1857
Mailing Address - Fax:
Practice Address - Street 1:8648 OLD SAVANNAH LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6610
Practice Address - Country:US
Practice Address - Phone:205-249-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist