Provider Demographics
NPI:1538630314
Name:GREEN, KIRA LAMAR (OTR/L)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:LAMAR
Last Name:GREEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:L
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24515 FLUTTERING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-4775
Mailing Address - Country:US
Mailing Address - Phone:206-947-7537
Mailing Address - Fax:
Practice Address - Street 1:7002 SETTLERS VILLAGE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6886
Practice Address - Country:US
Practice Address - Phone:206-947-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist