Provider Demographics
NPI:1114228947
Name:GREEN, ANTHONY LOUIS (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LOUIS
Last Name:GREEN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3010
Mailing Address - Country:US
Mailing Address - Phone:360-249-8252
Mailing Address - Fax:
Practice Address - Street 1:800 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5241
Practice Address - Country:US
Practice Address - Phone:360-788-8143
Practice Address - Fax:360-756-4848
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant