Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.0006928 | CO |
NPI | 1023689965 |
---|---|
Provider Name | Dr. Sophia Grimm |
First Address | Monument, CO 80132-6028 |
Second Address | Colorado Springs, CO 80906-4651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 01/07/2021 |