Provider Demographics
NPI:1134107568
Name:BEAVERCREEK HAND AND BODY THERAPY
Entity Type:Organization
Organization Name:BEAVERCREEK HAND AND BODY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRUHOT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L,CHT,CLT
Authorized Official - Phone:937-478-4210
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:OH
Mailing Address - Zip Code:45301-0140
Mailing Address - Country:US
Mailing Address - Phone:937-478-4210
Mailing Address - Fax:866-272-1218
Practice Address - Street 1:1525 XENIA AVE
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1123
Practice Address - Country:US
Practice Address - Phone:937-478-4210
Practice Address - Fax:866-272-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 225X00000X
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9362141Medicare PIN
OH5434570001Medicare NSC