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NPI Code Detail

MEDICARE: MS. KRISTINA LYNNE GREEN OT

MEDICARE: MS. KRISTINA LYNNE GREEN OT
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
1225X00000XOccupational Therapist2729SC
2225X00000XOccupational Therapist118743TX

General Provider Information

NPI Number : 1356685382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINA LYNNE GREEN OT
Provider Business Mailing Address
First Line : 501 FOREST LN
Second Line : SUITE A
City : CLEMSON
State : SC
Zip : 29631-2621
Country : US
Telephone Number : 864-654-2001
Fax Number : 800-305-7112
Provider Business Practice Location Address
First Line : 11110 TOM ADAMS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78753-3354
Country : US
Telephone Number : 512-836-1515
Fax Number : 855-232-8604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 10/15/2018

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