Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5707 | OR |
N | 225C00000X | Rehabilitation Counselor | AM0140 | OR |
NPI | 1275637266 |
---|---|
Provider Name | Mary Ann Green |
First Address | Portland, OR 97225-5185 |
Second Address | Portland, OR 97225-5185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 13/07/2007 |