Provider Demographics
NPI:1518568278
Name:GRUBB, ELISE JULIA (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:JULIA
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S DIXIE HWY UNIT 2103
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-5520
Mailing Address - Country:US
Mailing Address - Phone:231-907-8860
Mailing Address - Fax:
Practice Address - Street 1:1404 S DIXIE HWY UNIT 2310
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5524
Practice Address - Country:US
Practice Address - Phone:407-286-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty