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NPI Code Detail

MEDICARE: LUCILLE R GROOTERS OTR/L

MEDICARE: LUCILLE R GROOTERS 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
1225X00000XOccupational TherapistOT.0009217CO

General Provider Information

NPI Number : 1518652825
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCILLE R GROOTERS OTR/L
Provider Business Mailing Address
First Line : 230 GRIFFIN AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-4138
Country : US
Telephone Number : 719-597-0822
Fax Number :
Provider Business Practice Location Address
First Line : 1321 S PRAIRIE AVE, PUEBLO, CO 81005-2307
Second Line :
City : PUEBLO
State : CO
Zip : 81008-2176
Country : US
Telephone Number : 719-582-8736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2023
Last Update Date : 02/04/2026

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Directions to “ LUCILLE R GROOTERS OTR/L” Practice Location

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