Healthcare Provider Details

I. General information

NPI: 1003026931
Provider Name (Legal Business Name): REGINA M GRYWALSKI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 ATTUCKS DR SUITE B
POWELL OH
43065-6082
US

IV. Provider business mailing address

4823 RIVERSIDE DR
DELAWARE OH
43015-7901
US

V. Phone/Fax

Practice location:
  • Phone: 614-793-8720
  • Fax: 614-793-8722
Mailing address:
  • Phone: 740-881-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number000929
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: