Individual
LARRY JAMES GRONHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
621 RAYMOND LOOP, AUBURNDALE, FL 33823-2899
(863) 307-4142
Mailing address
621 RAYMOND LOOP, AUBURNDALE, FL 33823-2899
(863) 307-4142
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA13579
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
325120
NBCOT
—
Enumeration date
10/20/2016
Last updated
10/20/2016
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