Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT-005049 | OH |
NPI | 1043767403 |
---|---|
Provider Name | Mrs. Kelly Gruen |
First Address | Worthington, OH 43085-2823 |
Second Address | Powell, OH 43065-9168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2016 |
Last Update Date | 02/09/2016 |