Provider Demographics
NPI:1780411033
Name:BARANICK, GRACE ANN
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:BARANICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5626
Mailing Address - Country:US
Mailing Address - Phone:315-730-7052
Mailing Address - Fax:
Practice Address - Street 1:284 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:NY
Practice Address - Zip Code:14882-8930
Practice Address - Country:US
Practice Address - Phone:607-533-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63-P131177-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist