Healthcare Provider Details

I. General information

NPI: 1528405693
Provider Name (Legal Business Name): KATY ANN GRUBBS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N BOWMAN AVE
DANVILLE IL
61834-8108
US

IV. Provider business mailing address

24059 STATE ROUTE 1 UNIT 2
DANVILLE IL
61834-5995
US

V. Phone/Fax

Practice location:
  • Phone: 217-417-7055
  • Fax:
Mailing address:
  • Phone: 217-417-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002473A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: