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General NPI Number Information
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NPI Number | 1457476335
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Entity Type | Individual
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Provider Name | TAVEAN GRANT GREEN ATP, OTRL
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 200 MUIR RD KAISER HOME HEALTH DEPT - HACIENDA BLDG
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City | MARTINEZ
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State | CA
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Zip | 94553-4614
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Country | US
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Telephone | 925-313-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 2777 ENTRADA CIR
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City | ANTIOCH
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State | CA
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Zip | 94509-4231
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Country | US
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Telephone | 925-354-7901
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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 | OT2830
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | OT2830
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License Number State | CA
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