Individual
AMANDA MARIE GRUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1400 MEDICAL PARK DR, FORT WAYNE, IN 46825-5832
(260) 484-1558
Mailing address
PO BOX 83, MARK CENTER, OH 43536-0083
(574) 732-7895
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003383A
IN
224Z00000X
Occupational Therapy Assistant
OTA007230
OH
Other
Enumeration date
05/17/2023
Last updated
05/17/2023
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