Provider Demographics
NPI:1104635960
Name:GROGG, LORI LYNN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:GROGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 STATE HWY 71
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747
Mailing Address - Country:US
Mailing Address - Phone:605-745-8910
Mailing Address - Fax:605-745-7557
Practice Address - Street 1:1201 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-8800
Practice Address - Country:US
Practice Address - Phone:605-745-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1785224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty