Healthcare Provider Details

I. General information

NPI: 1033772942
Provider Name (Legal Business Name): DOMINIQUE AIDA GROSSMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

4495 HALE PKWY
DENVER CO
80220-6210
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax: 855-715-3504
Mailing address:
  • Phone: 844-757-7450
  • Fax: 855-715-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: