Tara Ryan Grandolfo, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

452293 Issued in IL

Practice address

550 Ridgeview Dr
McHenry, IL 60050

Phone

(815) 900-2500

NPI assigned

May 20, 2021

Last updated

May 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: tgrandolfo@ignitemedicalresorts.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1841865177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4723 W PEBBLE BEACH DR",
            "city": "WADSWORTH",
            "state": "IL",
            "postal_code": "600839276",
            "telephone_number": "224-436-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "815-900-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDOLFO",
        "first_name": "TARA",
        "middle_name": "RYAN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "452293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBCOT",
            "identifier": "452293",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Tgrandolfo@ignitemedicalresorts.org",
            "affiliation": "N",
            "endpointDescription": "Personal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4723 W Pebble Beach Dr",
            "city": "Wadsworth",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600839276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hunter Michelle Gourdie
• Satish P Gowda, M.D
• Cory Grabow, PTA
• Ashley Lashawn Graham-Cobb
• Anthony A Grande, MD
• Joan Grandrath
• Angeliqua Fonseca Grange, M.D.
• Mary Diane Grant
• Greater Elgin Family Care Center
• Greater Family Health (McHenry Community Health Center)

• Occupational Therapist in McHenry, IL
• Providers in McHenry, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.