Individual
KARISSA BREANNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2258
TN
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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