Most Relevant Information
Provider Data
| NPI Number: | 1003558107 |
| Provider Name: | GRANT FULLER OTA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 217275 |
Most Important Dates
| Enumeration Date: | 04/08/2022 |
| Last Updated: | 04/08/2022 |
Provider Practice Location
12770 COIT RD STE 870
DALLAS
TX
752511455
Practice Location Phone/Fax
| Phone: | 5017947866 |
| Fax: |
Provider Mailing Location
12770 COIT RD STE 870
DALLAS
TX
752511455
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |