Provider Demographics
NPI:1992683783
Name:GRANGE, MIRANDA (COTA/L)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:GRANGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:O'SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1908 THISTLE HILL DR APT 16309
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-7433
Mailing Address - Country:US
Mailing Address - Phone:775-842-2096
Mailing Address - Fax:
Practice Address - Street 1:1652 KELLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218244224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant