Provider Demographics
NPI:1801229166
Name:GRANDOWICZ, KATIE ROSE (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ROSE
Last Name:GRANDOWICZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:ROSE
Other - Last Name:SCHNELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:215 DUNBAR CAVE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8850
Mailing Address - Country:US
Mailing Address - Phone:931-542-2739
Mailing Address - Fax:
Practice Address - Street 1:215 DUNBAR CAVE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8850
Practice Address - Country:US
Practice Address - Phone:931-542-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4829225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics