Provider Demographics
NPI:1124911755
Name:GRANT, TAMI MICHELLE
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:MICHELLE
Last Name:GRANT
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 1:1216 CECIL NOEL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-8400
Mailing Address - Country:US
Mailing Address - Phone:270-706-3227
Mailing Address - Fax:
Practice Address - Street 1:1216 CECIL NOEL RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:KY
Practice Address - Zip Code:40008-8400
Practice Address - Country:US
Practice Address - Phone:270-706-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency