Healthcare Provider Details

I. General information

NPI: 1871404228
Provider Name (Legal Business Name): GRACE LINN THROCKMORTON C/OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7854 OLDFIELD RD
CRESTLINE OH
44827
US

IV. Provider business mailing address

490 GRAND ST UNIT B
GALION OH
44833-2540
US

V. Phone/Fax

Practice location:
  • Phone: 419-683-3647
  • Fax:
Mailing address:
  • Phone: 419-371-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: