Individual
MRS. TANYA RAE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701
(605) 755-1000
Mailing address
353 FAIRMONT BLVD, RAPID CITY, SD 57701
(605) 755-1000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0484
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0484
SD STATE LICENSURE
SD
Enumeration date
09/13/2007
Last updated
05/21/2021
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