Provider Demographics
NPI:1811386170
Name:GRIMM, ANGELA (OTA04816)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:OTA04816
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HOPEWELL RD N
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43746-9755
Mailing Address - Country:US
Mailing Address - Phone:740-624-0040
Mailing Address - Fax:
Practice Address - Street 1:1730 HOPEWELL RD N
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:OH
Practice Address - Zip Code:43746-9755
Practice Address - Country:US
Practice Address - Phone:740-624-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04816224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant