Provider Demographics
NPI:1679615470
Name:GREEN, CHRISTY (OT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:STE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:10511 19TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4279
Practice Address - Country:US
Practice Address - Phone:425-357-8885
Practice Address - Fax:425-357-8454
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003879225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8476475Medicaid
WA8476475Medicaid