Provider Demographics
NPI:1003026931
Name:GRYWALSKI, REGINA M (OT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:GRYWALSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7901
Mailing Address - Country:US
Mailing Address - Phone:740-881-2003
Mailing Address - Fax:
Practice Address - Street 1:3833 ATTUCKS DR
Practice Address - Street 2:SUITE B
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6082
Practice Address - Country:US
Practice Address - Phone:614-793-8720
Practice Address - Fax:614-793-8722
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000929225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics