=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992632459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY MIKI GREEN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2026
-----------------------------------------------------
Last Update Date | 05/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14905 BOTHELL EVERETT HWY
-----------------------------------------------------
City | MILL CREEK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98012-5315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-243-1298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4101 226TH PL SW
-----------------------------------------------------
City | MOUNTLAKE TERRACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98043-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-769-8421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Occupational Therapist
-----------------------------------------------------
License Number | 00003285
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------