=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164732954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH WALTER GROSS OTR/L, OTD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2010
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 698 MORRISON
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-686-1115
-----------------------------------------------------
Fax | 614-863-9338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 698 MORRISON
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-686-1115
-----------------------------------------------------
Fax | 614-863-9338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XE0001X
-----------------------------------------------------
Taxonomy Name | Environmental Modification Occupational Therapist
-----------------------------------------------------
License Number | 007132
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Occupational Therapist
-----------------------------------------------------
License Number | 007132
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------