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NPI Code Detail

MEDICARE: MELISSA LYNNE GREENE OTR/L

MEDICARE: MELISSA LYNNE GREENE OTR/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
1225X00000XOccupational Therapist105860MN

General Provider Information

NPI Number : 1053879130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LYNNE GREENE OTR/L
Provider Business Mailing Address
First Line : 5042 GLADSTONE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1309
Country : US
Telephone Number : 612-799-4315
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E 100TH ST
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2615
Country : US
Telephone Number : 952-888-7751
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2019
Last Update Date : 03/07/2019

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