| NPI | 1962842609 |
|---|---|
| Former Name | STEPHANIE NICOLE GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1648) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV LPT357) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-03-25 |