Provider Demographics
NPI:1023718566
Name:GRANT, WRENISHA LRATO
Entity type:Individual
Prefix:
First Name:WRENISHA
Middle Name:LRATO
Last Name:GRANT
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 1:80 CHATHAM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3289
Mailing Address - Country:US
Mailing Address - Phone:857-880-0325
Mailing Address - Fax:
Practice Address - Street 1:80 CHATHAM ST APT 1
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3289
Practice Address - Country:US
Practice Address - Phone:857-880-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist