Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. IVAN BROADERICK GRESHAM
ActiveMR. IVAN BROADERICK GRESHAM is a Occupational Therapist healthcare provider located in CALLAHAN, Florida. NPI 1457789653 is currently active in the NPPES registry. Verify at CMS.
Occupational Therapist · CALLAHAN, FL
Registration Details
- NPI Number
- 1457789653
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Oct 24, 2013 (12.764953964563 yrs)
- Last Updated
- Oct 24, 2013
- License
-
PTA24242 (FL)
Practice Information
- Address
-
45390 GREEN AVECALLAHAN, FL, 320113711Browse FL providers · Browse ZIP 32011
- Phone
- 9048791223
- Primary Specialty
-
Occupational Therapist
225200000X
Other Occupational Therapist Providers in CALLAHAN, FL
| Name | Credential | NPI |
|---|---|---|
| MR. JERRY LYNN EDWARDS | PTA | 1043554520 |
| JORDAN POWELL | PTA | 1326586058 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.