MEDICARE: MS. RACHEL JULIA GREEN RD, LD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1225793599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL JULIA GREEN RD, LD

Provider Business Mailing Address
First Line	:	79 W STARR AVE APT 2
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3449
Country	:	US
Telephone Number	:	330-495-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 W STARR AVE APT 2
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3449
Country	:	US
Telephone Number	:	330-495-1925
Fax Number	:

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

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	01/08/2024

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