Provider Demographics
NPI:1689919748
Name:GREEN, RENEE ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19406 TOMS HOLLOW RD SW
Mailing Address - Street 2:
Mailing Address - City:RAWLINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21557-1508
Mailing Address - Country:US
Mailing Address - Phone:301-876-7446
Mailing Address - Fax:
Practice Address - Street 1:19406 TOMS HOLLOW RD SW
Practice Address - Street 2:
Practice Address - City:RAWLINGS
Practice Address - State:MD
Practice Address - Zip Code:21557-1508
Practice Address - Country:US
Practice Address - Phone:301-876-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01974224Z00000X
WV1846224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant