Shelly Greenawalt, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.003950 Issued in IL

Practice address

500 Asbury Ave
Evanston, IL 60202-2724

Phone

(847) 316-3320

NPI assigned

Jun 16, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434412800000",
    "number": "1770964678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 S SEMORAN BLVD STE 110A",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327925313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ASBURY AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022724",
            "telephone_number": "847-316-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENAWALT",
        "first_name": "SHELLY",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2015-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.003950",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OH",
            "license": "OTA.04748",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "2258",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "SC",
            "license": "3049",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Bay Trail Dentistry
• Alysia L Green, MD
• Ian F Green, MD, MPH
• Terrence Green Sr.
• Theodora K Green, LSW, CADC RMA, DVA
• Karen Beth Greenberg, LCSW
• Steven Brett Greenberg, MD
• Kathy S. Greenberger, PSY.D.
• Constance Greene, LSW
• Ruth C Greenthal, PHD

• Occupational Therapy Assistant in Evanston, IL
• Providers in Evanston, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.