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NPI Code Detail

MEDICARE: OLIVIA GRACE GRINNELL

MEDICARE: OLIVIA GRACE GRINNELL
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
12255A2300XAthletic TrainerIN

General Provider Information

NPI Number : 1568312544
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA GRACE GRINNELL
Provider Business Mailing Address
First Line : 6127 THISTLEWOOD AVE
Second Line :
City : SCOTTS
State : MI
Zip : 49088-7713
Country : US
Telephone Number : 269-626-5963
Fax Number :
Provider Business Practice Location Address
First Line : 900 N JOHN R WOODEN DR
Second Line :
City : WEST LAFAYETTE
State : IN
Zip : 47907-2117
Country : US
Telephone Number : 800-497-7678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2026
Last Update Date : 01/30/2026

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Directions to “ OLIVIA GRACE GRINNELL ” Practice Location

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