Individual
MICKAYLA GROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
15 RIDGECREST CIR, LEWISBURG, PA 17837-6367
(570) 522-6234
Mailing address
425 BLOOM ST, DANVILLE, PA 17821-1609
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP008522
PA
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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