MEDICARE: TABATHA Y GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1003182296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABATHA Y GREENE

Provider Business Mailing Address
First Line	:	5312 OLD CHENEY HWY
Second Line	:	APT.C
City	:	ORLANDO
State	:	FL
Zip	:	32807-1935
Country	:	US
Telephone Number	:	407-223-4569
Fax Number	:

Provider Business Practice Location Address
First Line	:	5312 OLD CHENEY HWY
Second Line	:	APT.C
City	:	ORLANDO
State	:	FL
Zip	:	32807-1935
Country	:	US
Telephone Number	:	407-223-4569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2012
Last Update Date	:	04/01/2012

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Directions to “ TABATHA Y GREENE ” Practice Location

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