Provider Demographics
NPI:1770679060
Name:GREENE, SARAH SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUE
Last Name:GREENE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:SUE
Other - Last Name:GOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2683 LEYLAND TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3571
Mailing Address - Country:US
Mailing Address - Phone:651-207-6087
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40877300Medicaid
3582973OtherAETNA
15665OtherHEALTH PARTNERS
6404786OtherMEDICA
641671046996OtherPREFERRED ONE
MN97G20GROtherBCBS MN