Individual
GRACE MARIE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1381 CAMPBELL LN, BOWLING GREEN, KY 42104-1049
(270) 843-0587
Mailing address
4808 DUNMOR DEER LICK RD, LEWISBURG, KY 42256-8823
(270) 847-7048
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
172494
KY
Other
Enumeration date
05/29/2017
Last updated
05/29/2017
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