Provider Demographics
NPI:1114659836
Name:GRUNDLER, BETTINA E (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:E
Last Name:GRUNDLER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 W PALMER DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5052
Mailing Address - Country:US
Mailing Address - Phone:801-608-6334
Mailing Address - Fax:
Practice Address - Street 1:3905 LORRAINE PATH
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8630
Practice Address - Country:US
Practice Address - Phone:269-428-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist