Mattie Elyse Green, COTA,L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A1462 Issued in AR

Practice address

701 N Walton Blvd
Bentonville, AR 72712-4548

Phone

(479) 250-9838

NPI assigned

Jan 21, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1629668801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2764",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124548",
            "telephone_number": "479-250-9838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MATTIE",
        "middle_name": "ELYSE",
        "credential": "COTA,L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Computer",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "701 N Walton Blvd",
            "city": "Bentonville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727124548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Linda Leflett Gray, MHPP
• Amanda Lea Greathouse, MS, LAC
• Vania Greco
• Adam W. Green, MD
• Kyle Green, PHARM.D.
• Nia Green, RBT
• Patrick Tyler Greenburg
• Lauren E Greenhaw, PA-C
• Melody Rae Greer, LCSW
• Chelsey Greetan

• Occupational Therapy Assistant in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.