Provider Demographics
NPI:1366400616
Name:GRAVOIS, DENISE L (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:GRAVOIS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 ASBURY DR
Mailing Address - Street 2:STE A
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-4101
Mailing Address - Country:US
Mailing Address - Phone:985-674-4170
Mailing Address - Fax:985-674-4172
Practice Address - Street 1:594 ASBURY DR
Practice Address - Street 2:STE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-4101
Practice Address - Country:US
Practice Address - Phone:985-674-4170
Practice Address - Fax:985-674-4172
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 04292174400000X
LAOT 004292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4118541Medicare ID - Type Unspecified