Provider Demographics
NPI:1346777885
Name:GRAMLING, KANA KOENIG (OTR/L)
Entity Type:Individual
Prefix:
First Name:KANA
Middle Name:KOENIG
Last Name:GRAMLING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KANA
Other - Middle Name:LEIGH
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1174 MADISON GREEN LN SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4028 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3530
Practice Address - Country:US
Practice Address - Phone:770-942-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist