Healthcare Provider Details

I. General information

NPI: 1992632459
Provider Name (Legal Business Name): JOY MIKI GREEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14905 BOTHELL EVERETT HWY
MILL CREEK WA
98012-5315
US

IV. Provider business mailing address

4101 226TH PL SW
MOUNTLAKE TERRACE WA
98043-4559
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-1298
  • Fax:
Mailing address:
  • Phone: 206-769-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number00003285
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: