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General NPI Number Information
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NPI Number | 1336603471
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Entity Type | Individual
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Provider Name | DOLORES GROSSO
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 4100 RIVER RD
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City | EAST CHINA
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State | MI
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Zip | 48054-2909
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Country | US
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Telephone | 810-329-5385
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Fax | 810-329-8919
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Provider Business Mailing Address
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Address Line | 6740 SWAN CREEK RD
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City | FAIR HAVEN
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State | MI
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Zip | 48023
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Country | US
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Telephone | 586-725-1792
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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 | 5201003223
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License Number State | MI
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