Provider Demographics
NPI:1265178859
Name:MCCASH, GRETA ROSE (OTR)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:ROSE
Last Name:MCCASH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 W LAKE ELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54121-9151
Mailing Address - Country:US
Mailing Address - Phone:906-221-7533
Mailing Address - Fax:
Practice Address - Street 1:1225 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4312
Practice Address - Country:US
Practice Address - Phone:906-774-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI716726225X00000X
MI5201012767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist