Provider Demographics
NPI:1811648736
Name:GREEN, LAURA EMILY (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EMILY
Last Name:GREEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MENZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4440 CARVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5529
Mailing Address - Country:US
Mailing Address - Phone:513-791-5688
Mailing Address - Fax:
Practice Address - Street 1:4440 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5529
Practice Address - Country:US
Practice Address - Phone:513-791-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT007451OtherOTPTAT LICENSE BOARD