# GREEN RIVER OCCUPATIONAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Green River Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972794782
- **Authorized official:** MELISSA MATTINGLY-MARDIS OTR/L (OWNER/OTR)
- **Authorized official phone:** 12706928826

## Contact information

- **Practice address:** 991 MARTIN RD, CAMPBELLSVILLE, KY 42718-9726
- **Practice address phone:** (270) 789-4241
- **Practice address fax:** (270) 789-6531
- **Mailing address:** 991 MARTIN RD, CAMPBELLSVILLE, KY 42718-9726
- **Mailing address phone:** (270) 789-4241
- **Mailing address fax:** (270) 789-6531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | R2253 | KY | Yes |

## Other

- **Enumeration date:** 08/06/2007
- **Last updated:** 08/06/2007