Provider Demographics
NPI:1356638837
Name:GRIMM, KATHY R (LAC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:R
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15471 STANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9549
Mailing Address - Country:US
Mailing Address - Phone:330-830-3596
Mailing Address - Fax:330-830-2830
Practice Address - Street 1:4124 FULTON DRIVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-7063
Practice Address - Country:US
Practice Address - Phone:330-830-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist