Individual
KYOSHA GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3624 COUNTRY LN, LAKELAND, FL 33810-0238
(863) 934-6684
Mailing address
3624 COUNTRY LN, LAKELAND, FL 33810-0238
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT16247
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109618100
—
FL
Enumeration date
11/30/2016
Last updated
03/11/2021
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