Provider Demographics
NPI:1013000512
Name:GROSS, LOUANN (OT)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:GROSS
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 1:1164 N COUNTY ROAD 1400 E
Mailing Address - Street 2:
Mailing Address - City:KEMPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46049-9617
Mailing Address - Country:US
Mailing Address - Phone:765-210-0955
Mailing Address - Fax:765-210-0955
Practice Address - Street 1:1164 N COUNTY ROAD 1400 E
Practice Address - Street 2:
Practice Address - City:KEMPTON
Practice Address - State:IN
Practice Address - Zip Code:46049-9617
Practice Address - Country:US
Practice Address - Phone:765-210-0955
Practice Address - Fax:765-210-0955
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003891A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist