Provider Demographics
NPI:1174071955
Name:STEVENS, ERICA DAWN GRONAU (OTR/L MOT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN GRONAU
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OTR/L MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2409
Mailing Address - Country:US
Mailing Address - Phone:316-284-1583
Mailing Address - Fax:
Practice Address - Street 1:3012 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2409
Practice Address - Country:US
Practice Address - Phone:316-284-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2214225X00000X
IA083994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist