Individual
MRS. DEYANNA EVANGELA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4600 S STADIUM DR, APT 27, COLUMBUS, GA 31909-2133
(770) 899-3872
Mailing address
4600 S STADIUM DR, APT 27, COLUMBUS, GA 31909-2133
(770) 899-3872
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001312
GA
Other
Enumeration date
11/19/2012
Last updated
11/19/2012
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