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Individual
MR. TAVEAN GRANT GREEN
Active
Individual
MR. TAVEAN GRANT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATP, OTRL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2830
CA
246Z00000X
Other Specialist/Technologist
OT2830
CA
Other
Enumeration date
03/20/2007
Last updated
08/27/2008
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