Basic Information
| Provider Information | |||||||||
| NPI: | 1407259237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | PROSPECT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190762322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105866262 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 815 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | PROSPECT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190762322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105866262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC013578 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.