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General NPI Number Information
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NPI Number | 1497244552
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Entity Type | Individual
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Provider Name | KAYLA GRASSO
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Gender | Female
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 18444 139TH STREET EAST
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City | BONNEY LAKE
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State | WA
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Zip | 98391
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Country | US
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Telephone | 210-854-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 18444 139TH ST E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-5486
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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