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General NPI Number Information
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NPI Number | 1285919951
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Entity Type | Individual
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Provider Name | TAMMY L GREEN OTR
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Gender | Female
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 2040 HIGHWAY A1A STE 203
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3566
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Country | US
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Telephone | 321-773-8989
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Fax | 321-773-8990
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Provider Business Mailing Address
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Address Line | 110 MARTESIA WAY
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3569
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Country | US
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Telephone | 321-543-8026
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Fax |
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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 | OT3318
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License Number State | FL
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