MEDICARE: MS. MIRIAM GREENBAUM M.A.,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
1	225X00000X	Occupational Therapist	OT11760	FL

General Provider Information

NPI Number	:	1467545715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRIAM GREENBAUM M.A.,OTR/L

Provider Business Mailing Address
First Line	:	5937 ELM ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4111
Country	:	US
Telephone Number	:	727-842-9607
Fax Number	:

Provider Business Practice Location Address
First Line	:	5937 ELM ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4111
Country	:	US
Telephone Number	:	727-842-9607
Fax Number	:

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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