MEDICARE: STACY GREENO OT

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	OT6227	FL

General Provider Information

NPI Number	:	1407104938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY GREENO OT

Provider Business Mailing Address
First Line	:	4520 FONTANA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 FONTANA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1004
Country	:	US
Telephone Number	:	407-595-6295
Fax Number	:

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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Directions to “ STACY GREENO OT” Practice Location

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