Ambrose Green Jr., MOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201007262 Issued in MI

Practice address

35431 Avalon
Romulus, MI 48174

Phone

(734) 262-4576

Fax

(734) 721-7009

NPI assigned

Nov 9, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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": "1257724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1689901803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35431 AVALON ST",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481741724",
            "telephone_number": "734-262-4576",
            "fax_number": "734-721-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35431 AVALON",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "48174",
            "telephone_number": "734-262-4576",
            "fax_number": "734-721-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "AMBROSE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MOT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-09",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201007262",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "2776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Romulus, MI
• Providers in Romulus, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; 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.