Provider Demographics
NPI:1053656538
Name:GREENE, DEBORAH INY
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:INY
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:GAIL
Other - Last Name:INY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5918 PERFECT CALM CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1259
Mailing Address - Country:US
Mailing Address - Phone:410-428-1002
Mailing Address - Fax:
Practice Address - Street 1:18131 SLADE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1346
Practice Address - Country:US
Practice Address - Phone:301-260-1075
Practice Address - Fax:301-260-1075
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216665Medicare Oscar/Certification