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General NPI Number Information
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NPI Number | 1679377808
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Entity Type | Individual
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Provider Name | KIMBERLY GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 17406 ROYALTON RD STE C
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City | STRONGSVILLE
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State | OH
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Zip | 44136-5144
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Country | US
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Telephone | 440-663-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 GROVE LN
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City | MEDINA
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State | OH
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Zip | 44256-6781
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Country | US
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Telephone | 330-591-1304
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.011939
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License Number State | OH
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