Provider Demographics
NPI:1255087813
Name:GROVE, DANIELLE ELIZABETH (COTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:GROVE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21219 W AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50063-8195
Mailing Address - Country:US
Mailing Address - Phone:515-249-0639
Mailing Address - Fax:
Practice Address - Street 1:21219 W AVE
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-8195
Practice Address - Country:US
Practice Address - Phone:515-249-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000991224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant