Provider Demographics
NPI:1487823407
Name:GREEN, MONA FRANCES (LMT, NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:FRANCES
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 SW VOLCANO CIR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7898
Mailing Address - Country:US
Mailing Address - Phone:541-504-7108
Mailing Address - Fax:
Practice Address - Street 1:2963 SW VOLCANO CIR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7898
Practice Address - Country:US
Practice Address - Phone:541-504-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11817225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist