Provider Demographics
NPI:1699943555
Name:GREENAWALD, MICHELLE DINCECCO (MOT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DINCECCO
Last Name:GREENAWALD
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DINCECCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:3306 GREYFOX DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2683
Mailing Address - Country:US
Mailing Address - Phone:310-882-0098
Mailing Address - Fax:
Practice Address - Street 1:3306 GREYFOX DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2683
Practice Address - Country:US
Practice Address - Phone:310-882-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist