Healthcare Provider Details

I. General information

NPI: 1730914698
Provider Name (Legal Business Name): GRACE AYOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 MILESTONE CENTER DR STE 600
GERMANTOWN MD
20876-7102
US

IV. Provider business mailing address

3300 YELLOW FLOWER RD
LAUREL MD
20724-3201
US

V. Phone/Fax

Practice location:
  • Phone: 410-874-5215
  • Fax:
Mailing address:
  • Phone: 940-594-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberA00186369
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberT2W3R8F7
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberMT0090937
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: