Individual
NICOLE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
316 E LINCOLNWAY ST, WHEATLAND, IA 52777-9717
(563) 374-1295
Mailing address
812 4TH ST, DE WITT, IA 52742-1921
(563) 210-8293
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
084101
IA
Other
Enumeration date
02/11/2021
Last updated
02/11/2021
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