Healthcare Provider Details

I. General information

NPI: 1164732954
Provider Name (Legal Business Name): JOSEPH WALTER GROSS OTR/L, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MORRISON
COLUMBUS OH
43213
US

IV. Provider business mailing address

698 MORRISON
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-686-1115
  • Fax: 614-863-9338
Mailing address:
  • Phone: 614-686-1115
  • Fax: 614-863-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number007132
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number007132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: