Individual
HENRY DEWAYNE GRANDBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 HANCOCK, 501 HANCOCK, SAINT JOSEPH, LA 71366
(318) 535-4756
Mailing address
PO BOX 845, SAINT JOSEPH, LA 71366-0845
(318) 535-4756
Taxonomy
Speciality
Code
Description
License number
State
225XR0403X
Driving and Community Mobility Occupational Therapist
Primary
NA
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
LA
05
—
NA
—
LA
Enumeration date
09/11/2019
Last updated
09/11/2019
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