=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154951952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE OCCUPATIONAL THERAPY, HEALTH & WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2020
-----------------------------------------------------
Last Update Date | 01/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 7TH ST
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51537-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-284-1583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3012 COUNTRY CLUB PKWY
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51537-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-284-1583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | ERICA DAWN GRONAU STEVENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-284-1583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------