Individual
MATTIE ELYSE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA,L
Contact information
Practice address
701 N WALTON BLVD, BENTONVILLE, AR 72712-4548
(479) 250-9838
Mailing address
PO BOX 2764, BENTONVILLE, AR 72712-7704
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1462
AR
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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