Individual
GRACIE GUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
1622 INDIAN FORK RD, NEW MILTON, WV 26411-6185
(304) 871-6568
Mailing address
1622 INDIAN FORK RD, NEW MILTON, WV 26411-6185
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2385
WV
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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