Healthcare Provider Details

I. General information

NPI: 1295974608
Provider Name (Legal Business Name): DAVID LYNN GRINER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E QUEENWOOD RD
MORTON IL
61550-2926
US

IV. Provider business mailing address

190 E QUEENWOOD RD
MORTON IL
61550-2926
US

V. Phone/Fax

Practice location:
  • Phone: 309-266-9741
  • Fax: 309-266-6040
Mailing address:
  • Phone: 309-266-9741
  • Fax: 309-266-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056004926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: