Provider Demographics
NPI:1447682877
Name:GROTH, ELKE LYNNE
Entity type:Individual
Prefix:MS
First Name:ELKE
Middle Name:LYNNE
Last Name:GROTH
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 1:37 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2562
Mailing Address - Country:US
Mailing Address - Phone:518-563-0757
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2562
Practice Address - Country:US
Practice Address - Phone:518-563-0757
Practice Address - Fax:518-324-3697
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR311120224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant