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General NPI Number Information
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NPI Number | 1295432193
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Entity Type | Individual
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Provider Name | HEIDI GROSNICK OT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 403 E 1ST ST
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City | DIXON
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State | IL
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Zip | 61021-3116
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Country | US
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Telephone | 815-285-5531
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Fax | 815-285-5592
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Provider Business Mailing Address
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Address Line | 646 2ND AVE
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City | DIXON
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State | IL
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Zip | 61021-1914
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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 | 8090-26
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.008140
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License Number State | IL
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