Provider Demographics
NPI:1598949737
Name:GRENZ, CONNIE L (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:L
Last Name:GRENZ
Suffix:
Gender:F
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 1:303 EAST THIRD AVE
Mailing Address - Street 2:P.O. BOX 1215
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-1215
Mailing Address - Country:US
Mailing Address - Phone:406-225-3288
Mailing Address - Fax:
Practice Address - Street 1:303 EAST THIRD AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-1215
Practice Address - Country:US
Practice Address - Phone:406-225-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist