Provider Demographics
NPI:1104057868
Name:GRIZZELL, DOROTHY KIMBERLY (COTA/L)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:KIMBERLY
Last Name:GRIZZELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GRIZZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:101 E.STATE ST.
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQ.
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 LAFAYETTE AVE.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220
Practice Address - Country:US
Practice Address - Phone:513-221-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03944224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant