Individual
LISA M GRANTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2902 W AGUA FRIA FWY STE 1090, PHOENIX, AZ 85027-3970
(602) 648-5444
(602) 772-3801
Mailing address
33300 N 32ND AVE STE 320, PHOENIX, AZ 85085-8877
(602) 648-5444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-008633
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056005527
LICENSE
IL
Enumeration date
06/13/2006
Last updated
10/12/2022
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