Provider Demographics
NPI:1285727917
Name:GRUBB, DIANNA CAROL (DI)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:CAROL
Last Name:GRUBB
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 ROE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129
Mailing Address - Country:US
Mailing Address - Phone:606-686-1114
Mailing Address - Fax:606-686-1343
Practice Address - Street 1:2703 ROE CREEK RD
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129
Practice Address - Country:US
Practice Address - Phone:606-686-1114
Practice Address - Fax:606-686-1343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1746OtherFIRST STEP PROVIDER