Provider Demographics
NPI:1134297567
Name:ELSTON, GRETA ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:ANNE
Last Name:ELSTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GREENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9731
Mailing Address - Country:US
Mailing Address - Phone:406-439-4226
Mailing Address - Fax:406-442-0677
Practice Address - Street 1:43 GREENWOOD TRL
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-9731
Practice Address - Country:US
Practice Address - Phone:406-439-4226
Practice Address - Fax:406-442-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347412Medicaid
MT00050512Medicare ID - Type Unspecified