Provider Demographics
NPI:1821582214
Name:GROENINGER, AUDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:GROENINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:829 LOHOFF AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3152
Mailing Address - Country:US
Mailing Address - Phone:812-453-1276
Mailing Address - Fax:
Practice Address - Street 1:5311 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9286
Practice Address - Country:US
Practice Address - Phone:844-325-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006338A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist