Individual
GRANT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
12770 COIT RD STE 870, DALLAS, TX 75251-1455
(501) 794-7866
Mailing address
12770 COIT RD STE 870, DALLAS, TX 75251-1455
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
217275
TX
Other
Enumeration date
04/08/2022
Last updated
04/08/2022
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