Active NPI
Breanna Pauline Green
- Occupational Therapist
- Springfield, MO
National Provider Identifier
1679047633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2019000985
- Practice address
- 3023 S Fort Ave Ste B
Springfield, MO 65807-4217 - Phone
- (417) 890-4656
- Fax
- (417) 708-0889
- NPI assigned
- Jan 13, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 2019000985 | MO | Primary |
Addresses
Primary practice location
3023 S Fort Ave Ste B
Springfield, MO 65807-4217
Mailing address
3023 S Fort Ave Ste B
Springfield, MO 65807-4217
Phone (417) 890-4656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2019000985 | Other | MO | MO STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019000985 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547337600000",
"number": "1679047633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3023 S FORT AVE STE B",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658074217",
"telephone_number": "417-890-4656",
"fax_number": "417-708-0889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3023 S FORT AVE STE B",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658074217",
"telephone_number": "417-890-4656",
"fax_number": "417-708-0889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "BREANNA",
"middle_name": "PAULINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-13",
"last_updated": "2019-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2019000985",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO STATE LICENSE",
"identifier": "2019000985",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.