Healthcare Provider Details

I. General information

NPI: 1609299742
Provider Name (Legal Business Name): CAITLIN C GREENE OTD,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN CHANEY

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST SUITE 500
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-3340
  • Fax:
Mailing address:
  • Phone: 323-442-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: