Provider Demographics
NPI:1972721983
Name:GREENBERG, SUELLEN (OT)
Entity Type:Individual
Prefix:MS
First Name:SUELLEN
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 E WOBURN LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4090
Mailing Address - Country:US
Mailing Address - Phone:480-488-2800
Mailing Address - Fax:
Practice Address - Street 1:4650 WEST SWEETWATER AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AS
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225XP0200X225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics