Provider Demographics
NPI:1497050843
Name:GRUBB, KATRINA MAE (OT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MAE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8888
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8888
Mailing Address - Country:US
Mailing Address - Phone:901-259-4260
Mailing Address - Fax:901-259-2785
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-1600
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3941225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9552651OtherAETNA
TN620819926OtherCIGNA
TN4286434OtherBCBS TN
MS620819926OtherBCBS MS
TN620819926OtherTRICARE
TN620819926OtherAETNA
TN4286434OtherBCBS TN
TN9552651OtherAETNA