Provider Demographics
NPI:1467545715
Name:GREENBAUM, MIRIAM (MA,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5937 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4111
Mailing Address - Country:US
Mailing Address - Phone:727-842-9607
Mailing Address - Fax:
Practice Address - Street 1:5937 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4111
Practice Address - Country:US
Practice Address - Phone:727-842-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist