Provider Demographics
NPI:1891333910
Name:HOUTROUW, GRACE (OTR)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HOUTROUW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306-0149
Mailing Address - Country:US
Mailing Address - Phone:757-302-6140
Mailing Address - Fax:757-302-6140
Practice Address - Street 1:15405 MERRY CAT LANE
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-5222
Practice Address - Fax:757-442-6333
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist