Provider Demographics
NPI:1629512231
Name:GREEN, SARA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MESSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 ROSE PARK CRES
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4867
Mailing Address - Country:US
Mailing Address - Phone:732-886-3141
Mailing Address - Fax:
Practice Address - Street 1:17 ROSE PARK CRES
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4867
Practice Address - Country:US
Practice Address - Phone:732-886-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00761500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist