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General NPI Number Information
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NPI Number | 1992683783
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Entity Type | Individual
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Provider Name | MIRANDA GRANGE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1652 KELLER PKWY STE 100
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City | KELLER
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State | TX
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Zip | 76248-3876
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Country | US
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Telephone | 817-562-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 THISTLE HILL DR APT 16309
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City | FORT WORTH
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State | TX
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Zip | 76110-7433
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Country | US
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Telephone | 775-842-2096
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 218244
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License Number State | TX
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