Healthcare Provider Details

I. General information

NPI: 1710152384
Provider Name (Legal Business Name): CAROLINE GRINDROD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S JEFFERSON ST
VERONA WI
53593-1415
US

IV. Provider business mailing address

9 THORN LN
MADISON WI
53711-4349
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-1306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1478027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: