Healthcare Provider Details

I. General information

NPI: 1831755636
Provider Name (Legal Business Name): GRACE FRONCZAK OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 WALLER RD # 200
RICHMOND VA
23230-2912
US

IV. Provider business mailing address

1001 W 47TH ST
RICHMOND VA
23225-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-5010
  • Fax:
Mailing address:
  • Phone: 571-212-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119008188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: