Provider Demographics
NPI:1801343041
Name:GRUBBS, ONTERIA
Entity type:Individual
Prefix:
First Name:ONTERIA
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8728
Mailing Address - Country:US
Mailing Address - Phone:864-871-3064
Mailing Address - Fax:
Practice Address - Street 1:151 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8728
Practice Address - Country:US
Practice Address - Phone:864-871-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC160425-0227251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health