Provider Demographics
NPI:1447986427
Name:GRAMBLIN, ALEAH (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:ALEAH
Middle Name:
Last Name:GRAMBLIN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:LASANDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:204 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1523
Mailing Address - Country:US
Mailing Address - Phone:864-569-4589
Mailing Address - Fax:
Practice Address - Street 1:120 KAY DR STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-8913
Practice Address - Country:US
Practice Address - Phone:864-283-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management