Individual
MRS. BETH GROVE-SUPPOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
223 S PLEASANT STREET SUITE 301, OSPTA SOMERSET, SOMERSET, PA 15510
(412) 751-0040
(724) 483-3154
Mailing address
625 LINCOLN AVE, SUITE 107, N CHARLEROI, PA 15022
(724) 483-3610
(724) 489-4758
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC010191
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102211357 0001
—
PA
Enumeration date
10/13/2008
Last updated
05/06/2014
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