Individual
MS. IMANI MONIQUE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 TEXAS ST, FORT WORTH, TX 76102-3400
(817) 338-2400
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
217849
TX
Other
Enumeration date
05/29/2023
Last updated
05/29/2023
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