Healthcare Provider Details

I. General information

NPI: 1578327961
Provider Name (Legal Business Name): CALLIE ELIZABETH GREEN OTD/OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 REDMOND DRIVE
FLETCHER NC
28732-9313
US

IV. Provider business mailing address

184 WHETSTONE LN
MILLS RIVER NC
28759-5794
US

V. Phone/Fax

Practice location:
  • Phone: 828-775-8818
  • Fax:
Mailing address:
  • Phone: 828-775-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008181A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24666
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number124243
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: