Provider Demographics
NPI:1366227126
Name:GRAVES, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
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 609
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0609
Mailing Address - Country:US
Mailing Address - Phone:701-636-3217
Mailing Address - Fax:
Practice Address - Street 1:12 3RD ST SE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-4840
Practice Address - Country:US
Practice Address - Phone:701-636-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist