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General NPI Number Information
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NPI Number | 1710531470
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Entity Type | Individual
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Provider Name | MACKENZIE ELISE GRENTER MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 100 E LE FEVRE RD
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City | STERLING
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State | IL
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Zip | 61081-1279
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Country | US
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Telephone | 815-625-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 28598 2400 EAST ST
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City | LA MOILLE
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State | IL
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Zip | 61330-9597
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Country | US
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Telephone | 815-200-5213
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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 | 056.013125
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License Number State | IL
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