Provider Demographics
NPI:1003568528
Name:GRONOWSKI, CHASE (OTD, R/L)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:GRONOWSKI
Suffix:
Gender:M
Credentials:OTD, R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5247
Mailing Address - Country:US
Mailing Address - Phone:208-514-9349
Mailing Address - Fax:
Practice Address - Street 1:7150 POPLAR ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-2261
Practice Address - Country:US
Practice Address - Phone:303-289-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist