Healthcare Provider Details

I. General information

NPI: 1033874672
Provider Name (Legal Business Name): KELLY GREENINGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 37TH AVE N STE 220
PLYMOUTH MN
55446-3399
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5600
  • Fax:
Mailing address:
  • Phone: 651-968-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number106700
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: