Sherolyn Green, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

12320 Issued in CA

Practice address

3970 Shenandoah Dr
Oceanside, CA 92056-3329

Phone

(858) 205-3063

NPI assigned

Feb 23, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Mobile Therapy a Professional Physical Therapy Corp

  • Physical Therapist
  • Oceanside, CA
  • NPI 1962843078
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1053905737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 SHENANDOAH DR",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920563329",
            "telephone_number": "858-205-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 SHENANDOAH DR",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920563329",
            "telephone_number": "858-205-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SHEROLYN",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "12320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Althea D Green, RADT
• Brian Green
• Gabrielle Green
• Gaye Denise Green, MHS,OTR/L
• Michael Green, M.D.
• Jake Greenberg
• Richard M Greene Jr., PHD
• Parisa Tamasebi Greenland, OMT
• Melissa Greenway
• Sara Greetis, RD, CSOWM

• Occupational Therapist in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.