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General NPI Number Information
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NPI Number | 1811426158
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Entity Type | Individual
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Provider Name | KIMBERLY GROGAN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 1570 OAK AVE APT 401
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City | EVANSTON
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State | IL
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Zip | 60201-4269
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Country | US
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Telephone | 262-751-4445
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Fax | 262-751-4445
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Provider Business Mailing Address
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Address Line | N68W23921 DONNA DR
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City | SUSSEX
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State | WI
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Zip | 53089-2705
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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 |
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License Number State | IL
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