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General NPI Number Information
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NPI Number | 1023617636
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Entity Type | Individual
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Provider Name | GILLIAN MARIE GRIMSRUD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 15675 AMBAUM BLVD SW
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City | BURIEN
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State | WA
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Zip | 98166-2523
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Country | US
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Telephone | 206-631-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 15150 140TH WAY SE UNIT F201
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City | RENTON
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State | WA
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Zip | 98058-5817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60334411
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License Number State | WA
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