Provider Demographics
NPI:1316236201
Name:GREENE, ELLEN THERESA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:THERESA
Last Name:GREENE
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 1:661 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5431
Mailing Address - Country:US
Mailing Address - Phone:516-804-0314
Mailing Address - Fax:
Practice Address - Street 1:71 CLINTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4742
Practice Address - Country:US
Practice Address - Phone:516-396-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000688-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist