Provider Demographics
NPI:1952623456
Name:GREEN, VIRGINIA LEE SIEVERS (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE SIEVERS
Last Name:GREEN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:SIEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464 2ND STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331
Mailing Address - Country:US
Mailing Address - Phone:952-401-4242
Mailing Address - Fax:952-401-4285
Practice Address - Street 1:464 2ND STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331
Practice Address - Country:US
Practice Address - Phone:952-401-4242
Practice Address - Fax:952-401-4285
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104617225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics