Individual
JAMES RANDALL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
48 W 1500 N, NEPHI, UT 84648-8900
(435) 623-3100
Mailing address
238 E 900 N, NEPHI, UT 84648-1029
(435) 623-0604
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
108908-4201
UT
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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