Individual
MRS. LISA ANN GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
N7135 ROCKY KNOLL PKWY, PLYMOUTH, WI 53073-3103
(920) 893-6441
Mailing address
W6570 HWY MM, ELKHART LAKE, WI 53020-1508
(920) 980-9591
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1218.67
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1218.27
CERTIFIED OCC THERAPIST ASSISTANT
WI
Enumeration date
12/19/2011
Last updated
12/19/2011
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