Provider Demographics
NPI:1821740218
Name:GRUNING, DANNAE (COTA)
Entity Type:Individual
Prefix:
First Name:DANNAE
Middle Name:
Last Name:GRUNING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PORTCHESTER CASTLE PATH
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7457
Mailing Address - Country:US
Mailing Address - Phone:619-871-7550
Mailing Address - Fax:
Practice Address - Street 1:1112 E COPELAND RD STE 300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4910
Practice Address - Country:US
Practice Address - Phone:817-505-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2023-07-26
Deactivation Date:2023-07-05
Deactivation Code:
Reactivation Date:2023-07-26
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX217893224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician