Provider Demographics
NPI:1184813370
Name:GROVER, DRESDEN LOUISE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DRESDEN
Middle Name:LOUISE
Last Name:GROVER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9827
Mailing Address - Country:US
Mailing Address - Phone:336-951-4557
Mailing Address - Fax:336-951-4546
Practice Address - Street 1:618 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-0618
Practice Address - Country:US
Practice Address - Phone:336-951-4557
Practice Address - Fax:336-951-4546
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC010567Medicaid