Healthcare Provider Details

I. General information

NPI: 1861845745
Provider Name (Legal Business Name): CLARE GRINER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N LOOMIS ST
CHICAGO IL
60607-1147
US

IV. Provider business mailing address

310 N LOOMIS ST
CHICAGO IL
60607-1147
US

V. Phone/Fax

Practice location:
  • Phone: 314-221-5994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056011730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: