Provider Demographics
NPI:1891467395
Name:GRECO, SANDRA L (OT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GRECO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:SANDY
Other - Middle Name:L
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:534 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2613
Mailing Address - Country:US
Mailing Address - Phone:201-962-6212
Mailing Address - Fax:
Practice Address - Street 1:534 HIGH ST
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2613
Practice Address - Country:US
Practice Address - Phone:201-962-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00596400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist