Provider Demographics
NPI:1508131566
Name:GRUENWALD, WALTER (OTR/L)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:GRUENWALD
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 1:1168 NW KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-9289
Mailing Address - Country:US
Mailing Address - Phone:360-682-6141
Mailing Address - Fax:
Practice Address - Street 1:1168 NW KATHLEEN DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-9289
Practice Address - Country:US
Practice Address - Phone:360-682-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist