Healthcare Provider Details

I. General information

NPI: 1861670721
Provider Name (Legal Business Name): GREENTREE THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2008
Last Update Date: 02/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MAGNOLIA CIR SE
NORTH CANTON OH
44709-1183
US

IV. Provider business mailing address

700 MAGNOLIA CIR SE
NORTH CANTON OH
44709-1183
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-2833
  • Fax: 330-494-2840
Mailing address:
  • Phone: 330-494-2833
  • Fax: 330-494-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0003103
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002925
License Number StateOH

VIII. Authorized Official

Name: KAY M MALLOY
Title or Position: OWNER
Credential: PT
Phone: 330-494-2833