Individual
KELLY ANNE GRAYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3802 N 91ST AVE, PHOENIX, AZ 85037-2368
(623) 772-2378
Mailing address
534 E MARCO POLO RD, PHOENIX, AZ 85024-1033
(661) 889-5290
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4913
AZ
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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