Individual
KELLY LEE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
Mailing address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-17-44326
IN
225X00000X
Occupational Therapist
Primary
31007250A
IN
Other
Enumeration date
03/22/2019
Last updated
11/14/2023
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