Active NPI
Amy Green
- Pediatric Occupational Therapist
- Olive Branch, MS
National Provider Identifier
1730400441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT1693
- Practice address
- 9289 Plantation Oaks Dr
Olive Branch, MS 38654-6328 - Phone
- (662) 895-3003
- NPI assigned
- Jun 16, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT1693 | MS | Primary |
Addresses
Primary practice location
9289 Plantation Oaks Dr
Olive Branch, MS 38654-6328
Mailing address
9289 Plantation Oaks Dr
Olive Branch, MS 38654-6328
Phone (662) 895-3003
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 |
|---|---|---|---|
| OT1693 | MS | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276646400000",
"number": "1730400441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9289 PLANTATION OAKS DR",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386546328",
"telephone_number": "662-895-3003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9289 PLANTATION OAKS DR",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386546328",
"telephone_number": "662-895-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-16",
"last_updated": "2010-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MS",
"license": "OT1693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olive Branch, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.