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Individual

SHELLY GREENAWALT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
500 ASBURY AVE, EVANSTON, IL 60202-2724
(847) 316-3320
Mailing address
925 S SEMORAN BLVD STE 110A, WINTER PARK, FL 32792-5313

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003950
IL
224Z00000X
Occupational Therapy Assistant
2258
CA
224Z00000X
Occupational Therapy Assistant
3049
SC
224Z00000X
Occupational Therapy Assistant
OTA.04748
OH

Other

Enumeration date
06/16/2015
Last updated
06/16/2015
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