Provider Demographics
NPI:1699245043
Name:GROTE, WHITNEY MARIE (COTA)
Entity type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:MARIE
Last Name:GROTE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:MARIE
Other - Last Name:GROTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:67 RATERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SILEX
Mailing Address - State:MO
Mailing Address - Zip Code:63377-2910
Mailing Address - Country:US
Mailing Address - Phone:636-262-7930
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-348-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018029405224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant