MEDICARE: CAROLINE GRINDROD

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	224Z00000X	Occupational Therapy Assistant	1478027	WI

General Provider Information

NPI Number	:	1710152384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRINDROD

Provider Business Mailing Address
First Line	:	9 THORN LN
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-4349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 S JEFFERSON ST
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1415
Country	:	US
Telephone Number	:	608-845-1306
Fax Number	:

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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Directions to “ CAROLINE GRINDROD ” Practice Location

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