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General NPI Number Information
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NPI Number | 1083534408
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Entity Type | Individual
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Provider Name | JASON GREEN OT
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Gender | Male
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 1071 N BIRCH AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74012
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Country | US
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Telephone | 918-954-1080
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Fax | 918-999-9082
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Provider Business Mailing Address
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Address Line | 1071 N BIRCH AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74012
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Country | US
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Telephone | 918-954-1080
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Fax | 918-999-9082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1745
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License Number State | OK
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