Provider Demographics
NPI:1245471549
Name:GREEN-DOCTOR, ROCHELLE GLORIA (MA, OTR)
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:GLORIA
Last Name:GREEN-DOCTOR
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W 29TH ST
Mailing Address - Street 2:SUITE 3R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5210
Mailing Address - Country:US
Mailing Address - Phone:917-544-0897
Mailing Address - Fax:
Practice Address - Street 1:227 W 29TH ST
Practice Address - Street 2:SUITE 3R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5210
Practice Address - Country:US
Practice Address - Phone:917-544-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003187-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics