Individual
JOY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,OTR-L
Contact information
Practice address
6802 OLD MAIN HL, LOGAN, UT 84322-6802
(435) 797-1346
(844) 308-5865
Mailing address
6410 OLD MAIN HL, LOGAN, UT 84322-6410
(435) 797-1346
(844) 308-5865
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
9840712-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
876000528
1174694095
UT
Enumeration date
02/04/2019
Last updated
02/04/2019
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