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General NPI Number Information
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NPI Number | 1912654922
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Entity Type | Individual
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Provider Name | DAVID JOSEPH GRIGG
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Gender | Male
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 3400 SW 17TH PL FL 33914
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City | CAPE CORAL
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State | FL
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Zip | 33914-4919
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Country | US
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Telephone | 239-549-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 14151 GEORGIAN CIR APT 207
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City | FORT MYERS
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State | FL
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Zip | 33912-5620
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Country | US
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Telephone | 239-738-9244
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-190425
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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