Provider Demographics
NPI:1619180197
Name:GROSS, RENEE A (OTR)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E EGBERT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2404
Mailing Address - Country:US
Mailing Address - Phone:303-637-1039
Mailing Address - Fax:303-637-1033
Practice Address - Street 1:1850 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2404
Practice Address - Country:US
Practice Address - Phone:303-637-1039
Practice Address - Fax:303-637-1033
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONBCOT 987159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist