Provider Demographics
NPI:1942305859
Name:GREEN, ROHAUN SMITH (ROT)
Entity Type:Individual
Prefix:MRS
First Name:ROHAUN
Middle Name:SMITH
Last Name:GREEN
Suffix:
Gender:F
Credentials:ROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2817
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2817
Mailing Address - Country:US
Mailing Address - Phone:205-759-1211
Mailing Address - Fax:205-722-1009
Practice Address - Street 1:1110 6TH AVE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3207
Practice Address - Country:US
Practice Address - Phone:205-759-1211
Practice Address - Fax:205-722-1009
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531482OtherBLUE CROSS & BLUE SHIELD