MEDICARE: DANA KRISTINE GREENWELL MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT.007998	OH

General Provider Information

NPI Number	:	1003176421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA KRISTINE GREENWELL MOTR/L

Provider Business Mailing Address
First Line	:	1652 OLD HENDERSON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3618
Country	:	US
Telephone Number	:	614-459-6901
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 JASONWAY AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2458
Country	:	US
Telephone Number	:	614-459-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	03/28/2017

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