Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.0006691 | CO |
NPI | 1003568528 |
---|---|
Provider Name | Chase Gronowski |
First Address | Denver, CO 80220-5247 |
Second Address | Commerce City, CO 80022-2261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 25/01/2022 |