Provider Demographics
NPI:1134407091
Name:GREEN, SUSAN JOY (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOY
Last Name:GREEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOY
Other - Last Name:KITZMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:22714 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68002-5042
Mailing Address - Country:US
Mailing Address - Phone:402-478-5540
Mailing Address - Fax:
Practice Address - Street 1:22714 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:NE
Practice Address - Zip Code:68002-5042
Practice Address - Country:US
Practice Address - Phone:402-478-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE256224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant