Basic Information
| Provider Information | |||||||||
| NPI: | 1073087086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAVES | ||||||||
| FirstName: | CARLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | SPECIAL ED TEACHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 258 OLEAN ST | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140522533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162252217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 CENTRE DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141274100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166672294 | ||||||||
| FaxNumber: | 7166672272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2019 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.