Provider Demographics
NPI:1316128465
Name:GREEN, BRANDY DAVIS (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:DAVIS
Last Name:GREEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:508 GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3718
Mailing Address - Country:US
Mailing Address - Phone:910-395-4823
Mailing Address - Fax:
Practice Address - Street 1:1007 PORTERS NECK RD.
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-686-6506
Practice Address - Fax:910-686-6385
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5102224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant