Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT7632 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT7632 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT7632 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT7632 | CA |
NPI | 1952640054 |
---|---|
Provider Name | Gaye Denise Green |
First Address | Oceanside, CA 92058-1660 |
Second Address | Oceanside, CA 92058-1660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 08/02/2013 |