Individual
MRS. THAYDENE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8106 NW 74TH TER, TAMARAC, FL 33321-4861
(954) 200-3973
Mailing address
8106 NW 74TH TER, TAMARAC, FL 33321-4861
(954) 200-3973
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA12133
FL
Other
Enumeration date
01/14/2016
Last updated
01/14/2016
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