Individual
MRS. SUSAN LORAINE GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5601 BRIDGE ST, SUITE 401, FORT WORTH, TX 76112-2384
(817) 446-5000
(817) 332-7801
Mailing address
5601 BRIDGE ST, SUITE 401, FORT WORTH, TX 76112-2384
(817) 446-5000
(817) 332-7801
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
207832
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207832
LICENSE
TX
Enumeration date
08/31/2007
Last updated
02/28/2011
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