Provider Demographics
NPI:1275737330
Name:GRANGER, VONDA GAIL (MS, OTR)
Entity Type:Individual
Prefix:MISS
First Name:VONDA
Middle Name:GAIL
Last Name:GRANGER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TYBALT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5163
Mailing Address - Country:US
Mailing Address - Phone:317-388-8095
Mailing Address - Fax:317-388-8095
Practice Address - Street 1:4701 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1554
Practice Address - Country:US
Practice Address - Phone:317-722-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001025A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist