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NPI Code Detail

MEDICARE: AVALON GRANT-ELLIOTT

MEDICARE: AVALON GRANT-ELLIOTT
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
1225X00000XOccupational Therapist113365TX

General Provider Information

NPI Number : 1659896934
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVALON GRANT-ELLIOTT
Provider Business Mailing Address
First Line : 101 SUMMIT AVE STE 510
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-2613
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 SUMMIT AVE STE 510
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-2613
Country : US
Telephone Number : 682-730-0004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 08/08/2017

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Directions to “ AVALON GRANT-ELLIOTT ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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