Provider Demographics
NPI:1225345333
Name:GREEN-EGGLESTON, LIANE MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:MARIE
Last Name:GREEN-EGGLESTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COUNTY ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3439
Mailing Address - Country:US
Mailing Address - Phone:315-212-4971
Mailing Address - Fax:
Practice Address - Street 1:183 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2226
Practice Address - Country:US
Practice Address - Phone:518-483-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005842224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant