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Individual

KYLE ASHTON GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
304 EDMOND ST, APPALACHIA, VA 24216-2008
(276) 365-5301
Mailing address
304 EDMOND ST, APPALACHIA, VA 24216-2008
(276) 365-5301

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131001647
VA
224Z00000X
Occupational Therapy Assistant
Primary
OTA0000002802
TN

Other

Enumeration date
03/28/2017
Last updated
03/28/2017
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