Provider Demographics
NPI:1801624929
Name:GREENE, JAMES CHARLES JR (OTD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-1469
Mailing Address - Country:US
Mailing Address - Phone:401-529-6561
Mailing Address - Fax:
Practice Address - Street 1:501 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4347
Practice Address - Country:US
Practice Address - Phone:401-732-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist