Healthcare Provider Details

I. General information

NPI: 1013171164
Provider Name (Legal Business Name): ELLEN RUTH GREENHALGH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MOUNTAIN VIEW RD.
TRENTON ME
04605
US

IV. Provider business mailing address

PO BOX 934
ELLSWORTH ME
04605-0934
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-3889
  • Fax:
Mailing address:
  • Phone: 207-667-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1022
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: