MEDICARE: MR. PATRICK JERMAAL GREENE OTR-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT4021	TN
2	225X00000X	Occupational Therapist	120146	TX

General Provider Information

NPI Number	:	1154467298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK JERMAAL GREENE OTR-L

Provider Business Mailing Address
First Line	:	125 GAYOSO AVE APT 504
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2918
Country	:	US
Telephone Number	:	901-606-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 SENNA DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6727
Country	:	US
Telephone Number	:	704-841-2115
Fax Number	:	704-841-2402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2019

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