Provider Demographics
NPI:1811010770
Name:GRIMSLEY, GINGER (OTR-L)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:GRIMSLEY
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 1:5411 W REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8838
Mailing Address - Country:US
Mailing Address - Phone:479-254-1170
Mailing Address - Fax:
Practice Address - Street 1:5411 W REDBUD ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8838
Practice Address - Country:US
Practice Address - Phone:479-254-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR763225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics