Karissa Breanne Green, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Pleasant Hill, TN
NPI 1770189995 · NPPES record last updated Dec 11, 2020
Key facts
- NPI
- 1770189995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2258 (TN)
- Practice address
- 55 W Lake Rd
Pleasant Hill, TN 38578-3002 - Phone
- (931) 277-3511
- NPI assigned
- Dec 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2258 | TN | MD | Clinical Child & Adolescent Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2258 | TN | Yes |
Addresses
Primary practice location
55 W Lake Rd
Pleasant Hill, TN 38578-3002
Mailing address
9 Ponderosa Dr
Crossville, TN 38555-5806
Phone (931) 267-4693
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Karissa.green16@gmail.com |
Other providers in Pleasant Hill, TN
- Melissa Mary Dalton
- Matthew Thane Davis
- Sonia L Finch
- Amanda Fuentes
- Jason Gonzalez
- Janel L Hostetler
- Timothy Dwain Houston
- Benjamin Jordan
- Emalea Keyes
- Coy Daniel Kidd
All providers in Pleasant Hill, TN · Occupational Therapy Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.