Provider Demographics
NPI:1952394736
Name:GREENE, TERRY ROBERTSON (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ROBERTSON
Last Name:GREENE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0468
Mailing Address - Country:US
Mailing Address - Phone:434-392-4910
Mailing Address - Fax:434-392-8793
Practice Address - Street 1:1412 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2648
Practice Address - Country:US
Practice Address - Phone:434-392-1596
Practice Address - Fax:434-392-5201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146347OtherBLUE CROSS BLUE SHIELD
VA14190OtherOPTIMA HEALTH
VA23591OtherCARE NET
VA65549OtherSOUTHERN HEALTH
VA7475608OtherAETNA
VA21148OtherUNICARE
VA496619Medicare ID - Type Unspecified