Provider Demographics
NPI:1043767403
Name:GRUEN, KELLY (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:GRUEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WILSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2823
Mailing Address - Country:US
Mailing Address - Phone:614-450-6000
Mailing Address - Fax:614-883-3010
Practice Address - Street 1:1850 SUTTER PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9168
Practice Address - Country:US
Practice Address - Phone:614-450-4900
Practice Address - Fax:614-883-3260
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-005049225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics