Provider Demographics
NPI:1205527884
Name:GRAVES, COBY REBEKAH
Entity type:Individual
Prefix:
First Name:COBY
Middle Name:REBEKAH
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COBY
Other - Middle Name:REBEKAH
Other - Last Name:COODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:16755 CAIN RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-7544
Mailing Address - Country:US
Mailing Address - Phone:318-680-3282
Mailing Address - Fax:
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A342224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant