Basic Information
| Provider Information | |||||||||
| NPI: | 1942305859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | ROHAUN | ||||||||
| MiddleName: | SMITH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ROT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2817 | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354032817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057591211 | ||||||||
| FaxNumber: | 2057221009 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 6TH AVE E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354013207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057591211 | ||||||||
| FaxNumber: | 2057221009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 2325 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 51531482 | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER |