Basic Information
| Provider Information | |||||||||
| NPI: | 1497389662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8957 E BLUFF DR | ||||||||
| Address2: | |||||||||
| City: | PENN YAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145279245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155367263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 196 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144561651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157874000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2020 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 003764-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.