Provider Demographics
NPI:1902294473
Name:GROTHOFF, GINA MENZO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MENZO
Last Name:GROTHOFF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6101 CLARKE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6936
Mailing Address - Country:US
Mailing Address - Phone:704-947-8050
Mailing Address - Fax:
Practice Address - Street 1:6101 CLARKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6936
Practice Address - Country:US
Practice Address - Phone:704-947-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist