Healthcare Provider Details

I. General information

NPI: 1952640054
Provider Name (Legal Business Name): GAYE DENISE GREEN MHS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 TORREY PINES PL
OCEANSIDE CA
92058-1660
US

IV. Provider business mailing address

726 TORREY PINES PL
OCEANSIDE CA
92058-1660
US

V. Phone/Fax

Practice location:
  • Phone: 760-429-5373
  • Fax:
Mailing address:
  • Phone: 760-429-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT7632
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT7632
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT7632
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT7632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: