Provider Demographics
NPI:1316181324
Name:GROVER, PAMELS JO (COTA)
Entity Type:Individual
Prefix:
First Name:PAMELS
Middle Name:JO
Last Name:GROVER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N STARR AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1232
Mailing Address - Country:US
Mailing Address - Phone:715-246-5196
Mailing Address - Fax:
Practice Address - Street 1:242 N STARR AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1232
Practice Address - Country:US
Practice Address - Phone:715-246-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1772-027224Z00000X
MN201144224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant