Individual
JORDAN ALLEN GRANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2125 HILLIARD RD, RICHMOND, VA 23228-4600
(804) 266-9666
Mailing address
9421 EVERETTE CT, SPOTSYLVANIA, VA 22553-1978
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001954
VA
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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