Healthcare Provider Details

I. General information

NPI: 1649084856
Provider Name (Legal Business Name): MIKAELAH GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 200-E21
LANHAM MD
20706-6312
US

IV. Provider business mailing address

712 H ST NE STE 1509
WASHINGTON DC
20002-3627
US

V. Phone/Fax

Practice location:
  • Phone: 833-421-2796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: