Provider Demographics
NPI:1174308704
Name:GRIN, OLIVER DANIEL III (OTA)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:DANIEL
Last Name:GRIN
Suffix:III
Gender:M
Credentials:OTA
Other - Prefix:MR
Other - First Name:OLIVER
Other - Middle Name:DANIEL
Other - Last Name:GRIN
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:OTA/L
Mailing Address - Street 1:6585 NICHOLAS BLVD APT 604
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-7203
Mailing Address - Country:US
Mailing Address - Phone:352-355-0615
Mailing Address - Fax:
Practice Address - Street 1:701 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4616
Practice Address - Country:US
Practice Address - Phone:352-860-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11627224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant