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General NPI Number Information
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NPI Number | 1578442539
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Entity Type | Individual
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Provider Name | KYLIE RAE GREEN OTD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3200 CLEMENTS RD
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City | COTTONDALE
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State | AL
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Zip | 35453-2137
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Country | US
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Telephone | 205-752-7691
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Fax |
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Provider Business Mailing Address
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Address Line | 11317 CRIMSON RIDGE RD
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City | BROOKWOOD
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State | AL
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Zip | 35444-0857
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Country | US
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Telephone | 407-782-6703
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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 | 6753
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License Number State | AL
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