MEDICARE: MICHELE T GREENE MS, OTRL

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	OC005397L	PA

General Provider Information

NPI Number	:	1316163140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE T GREENE MS, OTRL

Provider Business Mailing Address
First Line	:	1019 KIMBALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3820
Country	:	US
Telephone Number	:	215-271-1266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 KIMBALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3820
Country	:	US
Telephone Number	:	215-271-1266
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	06/26/2011

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