Individual
MR. MARVIN IRA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
5930 ADOBE RD, TWENTYNINE PALMS, CA 92277-2356
(760) 367-1743
(760) 367-1083
Mailing address
PO BOX 34, 5462 ROY ROGERS ROAD, PIONEERTOWN, CA 92268-0034
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA552
CA
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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