Individual
GRACE WITHROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(866) 370-8206
Mailing address
1003 OAK GROVE CT, VALPARAISO, IN 46383-2049
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31007741A
OT LICENSE
IN
Enumeration date
06/30/2022
Last updated
10/20/2022
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