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General NPI Number Information
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NPI Number | 1083109144
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Entity Type | Individual
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Provider Name | THOMAS STEVEN GRUNWALD OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 6160 KEMPSVILLE CIR STE 300B
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City | NORFOLK
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State | VA
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Zip | 23502-3994
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Country | US
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Telephone | 757-892-6100
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Fax | 757-892-6111
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Provider Business Mailing Address
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Address Line | 7825 PROSPERITY TER
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City | HENRICO
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State | VA
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Zip | 23231-7672
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Country | US
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Telephone | 804-317-5465
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119007422
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License Number State | VA
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