Individual
SHANNON GRADY-TARENTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
40 MERRILL AVE, STATEN ISLAND, NY 10314-3312
(718) 370-7529
(718) 370-7551
Mailing address
50 LINCOLN BLVD, CLARK, NJ 07066-2530
(908) 966-6994
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
009275-1
NY
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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