Provider Demographics
NPI:1871692731
Name:GROGER, SANDRA E (OTD, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:E
Last Name:GROGER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WILLENA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2116
Mailing Address - Country:US
Mailing Address - Phone:256-783-5622
Mailing Address - Fax:256-325-3700
Practice Address - Street 1:4092 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4365
Practice Address - Country:US
Practice Address - Phone:256-882-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890015130Medicaid
AL51531972OtherBCBS