Provider Demographics
NPI:1306128145
Name:GRAHAM, ANN MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:BARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873-8429
Mailing Address - Country:US
Mailing Address - Phone:217-469-7265
Mailing Address - Fax:
Practice Address - Street 1:1505 PATTON DR
Practice Address - Street 2:BRIDLE BROOK ASSISTED LIVING
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-8116
Practice Address - Country:US
Practice Address - Phone:217-586-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist