Provider Demographics
NPI:1902274046
Name:GROTHAUS, KERRI (LAT, AT, ATC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:GROTHAUS
Suffix:
Gender:F
Credentials:LAT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21522 LEHMAN RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-8848
Mailing Address - Country:US
Mailing Address - Phone:419-979-2129
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1764
Practice Address - Country:US
Practice Address - Phone:260-665-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0054792255A2300X
IN36002808A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer