Provider Demographics
NPI:1154467298
Name:GREENE, PATRICK JERMAAL (OTR-L)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JERMAAL
Last Name:GREENE
Suffix:
Gender:M
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GAYOSO AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2918
Mailing Address - Country:US
Mailing Address - Phone:901-606-7880
Mailing Address - Fax:
Practice Address - Street 1:3029 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6727
Practice Address - Country:US
Practice Address - Phone:704-841-2115
Practice Address - Fax:704-841-2402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT4021225X00000X
TX120146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist