Provider Demographics
NPI:1164666806
Name:GREENBERGER, SHIRA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:GREENBERGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 239TH ST
Mailing Address - Street 2:APT 4K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1207
Mailing Address - Country:US
Mailing Address - Phone:347-346-9644
Mailing Address - Fax:
Practice Address - Street 1:600 W 239TH ST
Practice Address - Street 2:APT 4K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1207
Practice Address - Country:US
Practice Address - Phone:347-346-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013242-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist