Provider Demographics
NPI:1871198051
Name:GRUTMAN, VALENTINE (OT)
Entity Type:Individual
Prefix:
First Name:VALENTINE
Middle Name:
Last Name:GRUTMAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 SHORE PKWY APT 8C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7117
Mailing Address - Country:US
Mailing Address - Phone:646-541-4417
Mailing Address - Fax:
Practice Address - Street 1:1935 SHORE PKWY APT 8C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7117
Practice Address - Country:US
Practice Address - Phone:646-541-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty