Individual
THERESA LYNN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
30 COLBY CT, BEDFORD, NH 03110-6426
(603) 296-3705
Mailing address
2349 MAUVE TERACE, NORTH PORT, FL 34286
(603) 714-4475
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0440
NH
224Z00000X
Occupational Therapy Assistant
16472
FL
Other
Enumeration date
11/21/2012
Last updated
07/14/2021
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