Provider Demographics
NPI:1427260876
Name:GRAHAM, KORIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:KORIE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 33RD AVE. NE
Mailing Address - Street 2:
Mailing Address - City:FORDVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58231
Mailing Address - Country:US
Mailing Address - Phone:719-201-9548
Mailing Address - Fax:
Practice Address - Street 1:1000 S. COLUMBIA RD.
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1024205224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant