Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3607 | SC |
NPI | 1023633344 |
---|---|
Provider Name | Roberta Greene |
First Address | Mount Pleasant, SC 29466-6503 |
Second Address | Florence, SC 29505-8502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |