Healthcare Provider Details

I. General information

NPI: 1609052232
Provider Name (Legal Business Name): KATHRYN SUE GROTHEER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 NE KANE DR
GRESHAM OR
97030-4699
US

IV. Provider business mailing address

1995 IGLEHART AVE
SAINT PAUL MN
55104-5278
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-1965
  • Fax:
Mailing address:
  • Phone: 651-917-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1047895
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: