Active NPI
Randall Green, OT
- Occupational Therapist
- Clarkston, MI
National Provider Identifier
1477723740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201005754
- Practice address
- 7508 M E Cad Blvd
Suite a
Clarkston, MI 48348-4281 - Phone
- (248) 922-9200
- Fax
- (248) 922-9700
- NPI assigned
- Mar 3, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201005754 | MI | Primary |
Addresses
Primary practice location
7508 M E Cad Blvd
Suite a
Clarkston, MI 48348-4281
Mailing address
7508 M E Cad Blvd
Suite a
Clarkston, MI 48348-4281
Phone (248) 922-9200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040610000279 | MI | Practitioner - Occupational Therapist in Private Practice | 9133102239 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1477723740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7508 M E CAD BLVD",
"address_2": "SUITE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484281",
"telephone_number": "248-922-9200",
"fax_number": "248-922-9700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7508 M E CAD BLVD",
"address_2": "SUITE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484281",
"telephone_number": "248-922-9200",
"fax_number": "248-922-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "RANDALL",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-03",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201005754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
- Courtenay Elizabeth Grabowski, LM, LA, CBE
- Roberta Grabowski
- Christina Gramith, D.O.
- Greater Metro Detroit Senior Assistance LLC (Visiting Angels Services)
- Bianca Green, NP
- Gregory P. Derderian D.O., P.C.
- Daniel Scott Gregory, DPT
- Grey Street Counseling and Wellness
- Charles A. Griffith, MSW, LMSW
- Vanessa Rose Grover
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.