Provider Demographics
NPI:1821205204
Name:GROFF, DEANNA RAE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:RAE
Last Name:GROFF
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 1:1109 ASHLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837
Mailing Address - Country:US
Mailing Address - Phone:509-766-8249
Mailing Address - Fax:509-766-8249
Practice Address - Street 1:1109 ASHLEY WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837
Practice Address - Country:US
Practice Address - Phone:509-766-8249
Practice Address - Fax:509-766-8249
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602664277225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7683865Medicaid