=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891568846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELYN JOY GREENWOOD OTD, OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2023
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11049 MEMORIAL HERMANN DR STE 150
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-436-8869
-----------------------------------------------------
Fax | 713-436-1838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 BISSONNET ST APT 4302
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-1373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-725-7842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 124057
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------