Individual
STACY MARIE GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
459 PATTERSON RD BLDG 110, HONOLULU, HI 96819-1522
(808) 430-0090
Mailing address
1824 PUOWAINA DR, HONOLULU, HI 96813-1706
(503) 930-7454
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61430
NCTRC
—
Enumeration date
02/23/2021
Last updated
02/23/2021
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