MEDICARE: SARAH MARIE GRAMAN

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
1	222Q00000X	Developmental Therapist	000081158	KY

General Provider Information

NPI Number	:	1588802524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARIE GRAMAN

Provider Business Mailing Address
First Line	:	123 PLEASANT RIDGE AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2813
Country	:	US
Telephone Number	:	859-640-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 PLEASANT RIDGE AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2813
Country	:	US
Telephone Number	:	859-640-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	04/30/2017

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Directions to “ SARAH MARIE GRAMAN ” Practice Location

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