Provider Demographics
NPI:1104131341
Name:GRAJO, LENIN CARDENAS (EDM, OTR/L, OTRP)
Entity type:Individual
Prefix:MR
First Name:LENIN
Middle Name:CARDENAS
Last Name:GRAJO
Suffix:
Gender:M
Credentials:EDM, OTR/L, OTRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 NORTH CAPITAL OF TEXAS HWY
Mailing Address - Street 2:APT. 325
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:614-530-5013
Mailing Address - Fax:
Practice Address - Street 1:6507 JESTER BLVD.
Practice Address - Street 2:SUITE 309
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750
Practice Address - Country:US
Practice Address - Phone:512-343-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist