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NPI Code Detail

MEDICARE: GRACE HOLCOMB

MEDICARE: GRACE HOLCOMB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB1540400OK

General Provider Information

NPI Number : 1548118615
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE HOLCOMB
Provider Business Mailing Address
First Line : 504 NW FERRIS AVE
Second Line :
City : LAWTON
State : OK
Zip : 73507-5414
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1076 W MAPLE AVE
Second Line :
City : DUNCAN
State : OK
Zip : 73533-4787
Country : US
Telephone Number : 405-442-4940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ GRACE HOLCOMB ” Practice Location

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