Provider Demographics
NPI:1649590597
Name:GREINER, MICHAEL TERRY (MOT, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TERRY
Last Name:GREINER
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2801 N HALIFAX AVE
Mailing Address - Street 2:#131
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3177
Mailing Address - Country:US
Mailing Address - Phone:714-452-7024
Mailing Address - Fax:386-675-6757
Practice Address - Street 1:1 COBBLESTONE TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4306
Practice Address - Country:US
Practice Address - Phone:714-452-7024
Practice Address - Fax:386-675-6757
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist