Provider Demographics
NPI:1609052232
Name:GROTHEER, KATHRYN SUE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:SUE
Last Name:GROTHEER
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 1:1995 IGLEHART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5278
Mailing Address - Country:US
Mailing Address - Phone:651-917-7922
Mailing Address - Fax:
Practice Address - Street 1:1280 NE KANE DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4699
Practice Address - Country:US
Practice Address - Phone:503-667-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1047895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist