Healthcare Provider Details

I. General information

NPI: 1598098352
Provider Name (Legal Business Name): KRISTY INEZ GRONSETH OTR/L, CDRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KRISTY INEZ SCHWARTZ

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 07/12/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ELM ST. LOVELACE REHABILITATION HOSPITAL
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

7508 DEERFIELD RD NW
ALBUQUERQUE NM
87120-4530
US

V. Phone/Fax

Practice location:
  • Phone: 505-229-0319
  • Fax:
Mailing address:
  • Phone: 865-659-3112
  • Fax: 505-727-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2609
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: