Provider Demographics
NPI:1194191510
Name:GRIMMER, MIRANDA (MT-BC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:GRIMMER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 WELCOME WAY
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6852
Mailing Address - Country:US
Mailing Address - Phone:417-529-5903
Mailing Address - Fax:
Practice Address - Street 1:407 WELCOME WAY
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6852
Practice Address - Country:US
Practice Address - Phone:417-529-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist