Healthcare Provider Details

I. General information

NPI: 1801229166
Provider Name (Legal Business Name): KATIE ROSE GRANDOWICZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE ROSE SCHNELLER OTD, OTR/L

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

IV. Provider business mailing address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2739
  • Fax:
Mailing address:
  • Phone: 931-542-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4829
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: