Provider Demographics
NPI:1497874499
Name:PORTER, JOANN GREENE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:GREENE
Last Name:PORTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JOANN
Other - Middle Name:NANCY
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:15 HAMMOND ST
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0408
Mailing Address - Country:US
Mailing Address - Phone:508-758-6968
Mailing Address - Fax:
Practice Address - Street 1:389 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4995
Practice Address - Country:US
Practice Address - Phone:508-997-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH-6049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist