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NPI Code Detail

MEDICARE: KRISTEN GRIDER OT

MEDICARE: KRISTEN GRIDER OT
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 Therapist056-007991IL

General Provider Information

NPI Number : 1770761512
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN GRIDER OT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4080 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-1831
Country : US
Telephone Number : 773-545-1153
Fax Number : 773-545-1588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2008
Last Update Date : 10/06/2016

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