Individual
MISS GRACIE AGNES GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5851 BELLE VALE DR, VANCLEAVE, MS 39565-7260
(228) 282-3691
Mailing address
5851 BELLE VALE DR, VANCLEAVE, MS 39565-7260
(228) 282-3691
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
MS
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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