MEDICARE: MS. DENISE GROSSMAN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.002446	IL

General Provider Information

NPI Number	:	1164662235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE GROSSMAN OTR/L

Provider Business Mailing Address
First Line	:	6558 N TROY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4119
Country	:	US
Telephone Number	:	773-459-6055
Fax Number	:	773-381-4531

Provider Business Practice Location Address
First Line	:	1052 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4240
Country	:	US
Telephone Number	:	847-439-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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