Provider Demographics
NPI:1376389098
Name:GRABER, MIKAYLA
Entity type:Individual
Prefix:MRS
First Name:MIKAYLA
Middle Name:
Last Name:GRABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 RICHMOND PLACE DR APT 725
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1727
Mailing Address - Country:US
Mailing Address - Phone:352-426-2248
Mailing Address - Fax:
Practice Address - Street 1:18002 RICHMOND PLACE DR APT 725
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1727
Practice Address - Country:US
Practice Address - Phone:352-426-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI57662355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty