Provider Demographics
NPI:1497111371
Name:GROEBEL, ELISABETH (OTR/L)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:GROEBEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2602
Mailing Address - Country:US
Mailing Address - Phone:484-769-1222
Mailing Address - Fax:
Practice Address - Street 1:9827 MAPLE GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4491
Practice Address - Country:US
Practice Address - Phone:484-769-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist