Provider Demographics
NPI:1194440214
Name:REEVES, GRACE C (OT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:REEVES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:C
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:921 W BEACON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-3229
Mailing Address - Country:US
Mailing Address - Phone:601-650-0002
Mailing Address - Fax:
Practice Address - Street 1:322 HWY 80 E
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4726
Practice Address - Country:US
Practice Address - Phone:662-259-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist