Individual
ELLIOT GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19525 W NORTH AVE, BROOKFIELD, WI 53045-4107
(262) 780-3813
Mailing address
19525 W NORTH AVE, BROOKFIELD, WI 53045-4107
(262) 780-3813
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5636-26
WI
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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