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General NPI Number Information
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NPI Number | 1649084856
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Entity Type | Individual
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Provider Name | MIKAELAH GRANT
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 4500 FORBES BLVD STE 200-E21
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City | LANHAM
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State | MD
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Zip | 20706-6312
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Country | US
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Telephone | 833-421-2796
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Fax |
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Provider Business Mailing Address
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Address Line | 712 H ST NE STE 1509
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | DC
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