Provider Demographics
NPI:1629506936
Name:GREENE, KERI (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 BOWMAN STREET RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-8807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 HIGH SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1576
Practice Address - Country:US
Practice Address - Phone:419-342-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH380284OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY (NBCOT)
OHOH3278075OtherOHIO DEPARTMENT OF EDUCATION
OHOT009735OtherOHIO OT PT AT BOARD