Provider Demographics
NPI:1689864084
Name:GRECHKO, JUDITH ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:GRECHKO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:TARBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:740 S PLACENTIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6832
Mailing Address - Country:US
Mailing Address - Phone:714-646-8318
Mailing Address - Fax:714-646-8320
Practice Address - Street 1:740 S PLACENTIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6832
Practice Address - Country:US
Practice Address - Phone:714-646-8318
Practice Address - Fax:714-646-8320
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist