Healthcare Provider Details

I. General information

NPI: 1053722058
Provider Name (Legal Business Name): TAMMY L GRIMES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTRAL ROW RD
ELSMERE KY
41018-2319
US

IV. Provider business mailing address

1401 CENTRAL ROW RD
ELSMERE KY
41018-2319
US

V. Phone/Fax

Practice location:
  • Phone: 513-923-7936
  • Fax:
Mailing address:
  • Phone: 513-923-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2369
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: