Provider Demographics
NPI:1023340833
Name:GRUBBS, CAROLINE JEAN (OTR)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JEAN
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:JEAN
Other - Last Name:DENSLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:19807 MALONE RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7212
Mailing Address - Country:US
Mailing Address - Phone:214-621-5941
Mailing Address - Fax:
Practice Address - Street 1:6400 N SANTA FE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist