Henry Dewayne Grandberry

Primary specialty

Driving and Community Mobility Occupational TherapistTaxonomy code 225XR0403X

License

NA Issued in LA

Practice address

501 Hancock
501 Hancock
Saint Joseph, LA 71366

Phone

(318) 535-4756

NPI assigned

Sep 11, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1578112686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845",
            "city": "SAINT JOSEPH",
            "state": "LA",
            "postal_code": "713660845",
            "telephone_number": "318-535-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 HANCOCK",
            "address_2": "501 HANCOCK",
            "city": "SAINT JOSEPH",
            "state": "LA",
            "postal_code": "71366",
            "telephone_number": "318-535-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDBERRY",
        "first_name": "HENRY",
        "middle_name": "DEWAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XR0403X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": "LA",
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "NA",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "NA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "501 Hancock",
            "address_2": "501 Hancock",
            "city": "Saint Joseph",
            "state": "LA",
            "country_code": "US",
            "postal_code": "71366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Occupational Therapist in Saint Joseph, LA
• Providers in Saint Joseph, LA by specialty
• Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.