Healthcare Provider Details

I. General information

NPI: 1982995437
Provider Name (Legal Business Name): CHRISTINE GREENE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E 1ST ST
FORT MYERS FL
33901-2465
US

IV. Provider business mailing address

522 SE 13TH ST
CAPE CORAL FL
33990-2060
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-5371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 11532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: