Provider Demographics
NPI:1487608956
Name:RAINES, GRESHUNDRIA MANIK (OTR)
Entity type:Individual
Prefix:MRS
First Name:GRESHUNDRIA
Middle Name:MANIK
Last Name:RAINES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240243
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0243
Mailing Address - Country:US
Mailing Address - Phone:334-514-4953
Mailing Address - Fax:
Practice Address - Street 1:915 S JACKSON ST
Practice Address - Street 2:ASU, DEPARTMENT OF OCCUPATIONAL THERAPY
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-5732
Practice Address - Country:US
Practice Address - Phone:334-229-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist