Individual
CASEY LYNN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6025 PINE AVE, MAYWOOD, CA 90270-3108
(323) 560-0720
Mailing address
10612 WAYCROSS AVE, LOUISVILLE, KY 40229-5320
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
11688
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11688
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
05/26/2011
Last updated
05/26/2011
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