Provider Demographics
NPI:1023012499
Name:GROOVER, KATHERINE LEA (OC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEA
Last Name:GROOVER
Suffix:
Gender:F
Credentials:OC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEA
Other - Last Name:EHLENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:479 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-9401
Mailing Address - Country:US
Mailing Address - Phone:610-767-3821
Mailing Address - Fax:570-424-2346
Practice Address - Street 1:109 SEVEN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9100
Practice Address - Country:US
Practice Address - Phone:517-421-1254
Practice Address - Fax:570-424-2346
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007027L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394529Medicare ID - Type Unspecified