Individual
JIMMMYE DALE GREEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L,CEAS
Contact information
Practice address
2648 SEVIERVILLE RD, MARYVILLE, TN 37804-3643
(865) 984-1660
Mailing address
1843 HIGHWAY 4 E, HOLLY SPRINGS, MS 38635-9744
(662) 544-2771
Taxonomy
Speciality
Code
Description
License number
State
225XE1200X
Ergonomics Occupational Therapist
Primary
0000003798
TN
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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