Provider Demographics
NPI:1255784971
Name:GREEN, VANESSA (MS ED, BS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS ED, BS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 HAMPTON KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JAMES A RHODES ARENA
Practice Address - Street 2:373 CARROLL STREET
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-0001
Practice Address - Country:US
Practice Address - Phone:918-409-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0044802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer