Individual
BROOKE NICOLE GRANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
394 HEISLER CT, CRYSTAL LAKE, IL 60014
(801) 318-3014
Mailing address
394 HEISLER CT, CRYSTAL LAKE, IL 60014-7620
(801) 318-3014
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010458
IL
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
09/22/2014
Last updated
10/10/2018
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