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General NPI Number Information
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NPI Number | 1518449610
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Entity Type | Individual
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Provider Name | KRISTIN GRIMLAND
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 9212 N KELLEY AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73131-2419
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Country | US
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Telephone | 405-242-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 NW 31ST TER
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City | BETHANY
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State | OK
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Zip | 73008-4012
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Country | US
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Telephone | 405-474-7898
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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