Provider Demographics
NPI:1437251790
Name:WILSON, ELLEN GREBINGER (OT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GREBINGER
Last Name:WILSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SOUTH GREEN ROAD
Mailing Address - Street 2:SUITE #036
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-291-2277
Mailing Address - Fax:216-291-5707
Practice Address - Street 1:1611 SOUTH GREEN ROAD
Practice Address - Street 2:SUITE #036
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-291-2277
Practice Address - Fax:216-291-5707
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT4580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI4170281Medicare ID - Type Unspecified