Healthcare Provider Details

I. General information

NPI: 1033350475
Provider Name (Legal Business Name): DANETTE L GREEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 1ST AVE
FRANKLINVILLE NY
14737-1318
US

IV. Provider business mailing address

29 1ST AVE
FRANKLINVILLE NY
14737-1318
US

V. Phone/Fax

Practice location:
  • Phone: 716-560-8747
  • Fax:
Mailing address:
  • Phone: 716-560-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008208-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: