MEDICARE: KENADEE GROBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	226000000X	Recreational Therapist Assistant		UT

General Provider Information

NPI Number	:	1881563344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENADEE GROBERG

Provider Business Mailing Address
First Line	:	1205 E BONNER WAY
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 E BONNER WAY
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4917
Country	:	US
Telephone Number	:	801-262-2908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “ KENADEE GROBERG ” Practice Location

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