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General NPI Number Information
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NPI Number | 1386189728
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Entity Type | Individual
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Provider Name | JACQUELINE GREEN
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Gender | Female
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 4019 18TH ST S
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City | ARLINGTON
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State | VA
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Zip | 22204-5141
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Country | US
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Telephone | 703-967-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 4703 W BRADDOCK RD APT 30
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City | ALEXANDRIA
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State | VA
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Zip | 22311-4706
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Country | US
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Telephone | 814-233-1450
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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 | 0119005764
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License Number State | VA
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