Provider Demographics
NPI:1598109720
Name:GROVER, DEEPAK (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:GROVER
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 1:10426 SOUTH ROBERTS ROAD
Mailing Address - Street 2:PALOS HILLS HEALTH CENTER
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1932
Mailing Address - Country:US
Mailing Address - Phone:708-598-3460
Mailing Address - Fax:
Practice Address - Street 1:10426 SOUTH ROBERTS ROAD
Practice Address - Street 2:PALOS HILLS HEALTH CENTER
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1932
Practice Address - Country:US
Practice Address - Phone:708-598-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist