Provider Demographics
NPI:1649638156
Name:GREENER, MELISSA (COTA/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GREENER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N LINE ST
Mailing Address - Street 2:APT U301
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1043
Mailing Address - Country:US
Mailing Address - Phone:215-809-2942
Mailing Address - Fax:
Practice Address - Street 1:2100 N LINE ST
Practice Address - Street 2:APT U301
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1043
Practice Address - Country:US
Practice Address - Phone:215-809-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007481224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant