Lavarre Green, OTR

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

119090 Issued in TX

Practice address

9939 Fredericksburg Rd Apt 1815
San Antonio, TX 78240-4158

Phone

(504) 300-7425

NPI assigned

Dec 14, 2020

Last updated

Dec 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Pur Occupational Therapy Services LLC

  • Home Health Agency
  • San Antonio, TX
  • NPI 1073226841
  NPD Authorized official

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

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1487240446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9939 FREDERICKSBURG RD APT 1815",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404158",
            "telephone_number": "504-300-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9939 FREDERICKSBURG RD APT 1815",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404158",
            "telephone_number": "504-300-7425"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Hilltop Rd",
            "address_purpose": "LOCATION",
            "city": "Kerrville",
            "state": "TX",
            "postal_code": "780282851",
            "country_code": "US",
            "telephone_number": "830-895-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LAVARRE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-14",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "119090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Eddie Green, DDS
• John Edward Green III, MD
• John Robert Green III, MD
• Karen Green, PA-C
• Keesha Ann Green
• Margaret Faye Green
• Melvin Richard Green Jr., LMT
• Molleigh Green
• Olivia Green, CNM
• Otha Green Jr., PT

• Physical Medicine & Rehabilitation Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.