Provider Demographics
NPI:1174118988
Name:GROETKEN, PAIGE (OT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GROETKEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 S 34TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4793
Mailing Address - Country:US
Mailing Address - Phone:712-541-1365
Mailing Address - Fax:
Practice Address - Street 1:6105 S 34TH ST APT 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4793
Practice Address - Country:US
Practice Address - Phone:712-541-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist