Provider Demographics
NPI:1922377530
Name:GREENWALD, ILENE MERYL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:MERYL
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:53 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2308
Mailing Address - Country:US
Mailing Address - Phone:617-630-9010
Mailing Address - Fax:617-517-9160
Practice Address - Street 1:333 NAHANTON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-630-9010
Practice Address - Fax:617-517-9160
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2246225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision