Individual
MS. KIMBERLY RENEE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
4878 W PARK CIR, ATLANTA, GA 30349-2049
(843) 254-7671
Mailing address
4878 W PARK CIR, ATLANTA, GA 30349-2049
(843) 254-7671
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005891
GA
225XE0001X
Environmental Modification Occupational Therapist
OT005891
GA
225XP0019X
Physical Rehabilitation Occupational Therapist
OT005891
GA
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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