Provider Demographics
NPI:1083109144
Name:GRUNWALD, THOMAS STEVEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEVEN
Last Name:GRUNWALD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 PROSPERITY TER
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7672
Mailing Address - Country:US
Mailing Address - Phone:804-317-5465
Mailing Address - Fax:
Practice Address - Street 1:6160 KEMPSVILLE CIR STE 300B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3994
Practice Address - Country:US
Practice Address - Phone:757-892-6100
Practice Address - Fax:757-892-6111
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007422225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics