Provider Demographics
NPI:1386974657
Name:GRIFFIN, ANTWON JAMEL (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ANTWON
Middle Name:JAMEL
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 MANDY PLACE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8789
Mailing Address - Country:US
Mailing Address - Phone:252-945-7398
Mailing Address - Fax:
Practice Address - Street 1:1346 MANDY PLACE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8789
Practice Address - Country:US
Practice Address - Phone:252-945-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5686225X00000X
NC12795225X00000X
NC6519224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist