Provider Demographics
NPI:1871643346
Name:GROSDIDIER, CARRIE V (OTR)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:V
Last Name:GROSDIDIER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25915 W 150TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8507
Mailing Address - Country:US
Mailing Address - Phone:913-205-7223
Mailing Address - Fax:913-205-7223
Practice Address - Street 1:25915 W 150TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8507
Practice Address - Country:US
Practice Address - Phone:913-205-7223
Practice Address - Fax:913-205-7223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00826225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS35824021OtherBC&BS PROVIDER NUMBER