Provider Demographics
NPI:1003182296
Name:GREENE, TABATHA Y
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:Y
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 OLD CHENEY HWY
Mailing Address - Street 2:APT.C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1935
Mailing Address - Country:US
Mailing Address - Phone:407-223-4569
Mailing Address - Fax:
Practice Address - Street 1:5312 OLD CHENEY HWY
Practice Address - Street 2:APT.C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1935
Practice Address - Country:US
Practice Address - Phone:407-223-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist