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NPI Code Detail

MEDICARE: ROBIN CHRISTINE GRANT

MEDICARE: ROBIN CHRISTINE GRANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant202124MN

General Provider Information

NPI Number : 1003372160
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN CHRISTINE GRANT
Provider Business Mailing Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 651-202-6195
Fax Number :
Provider Business Practice Location Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 612-214-0861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2019
Last Update Date : 02/13/2019

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