Individual
KYRA GRAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 585-6884
Mailing address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6699-26
WI
Other
Enumeration date
05/04/2020
Last updated
05/04/2020
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