Individual
AMY GRIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
593 EDDY ST, GEORGE CLINIC, PROVIDENCE, RI 02903-4923
(401) 444-3201
Mailing address
593 EDDY ST, HASBRO 122, PROVIDENCE, RI 02903-4923
(401) 444-3201
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA00412
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA00412
LICENSE
RI
Enumeration date
01/09/2008
Last updated
01/09/2008
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