Provider Demographics
NPI:1578282323
Name:GREEN, EMILY (CTRS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 LAKESHORE BLVD APT 710
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6937
Mailing Address - Country:US
Mailing Address - Phone:734-780-5408
Mailing Address - Fax:
Practice Address - Street 1:2429 LAKESHORE BLVD APT 710
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6937
Practice Address - Country:US
Practice Address - Phone:734-780-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist