Provider Demographics
NPI:1578442539
Name:GREEN, KYLIE RAE (OTD)
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:RAE
Last Name:GREEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11317 CRIMSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35444-0857
Mailing Address - Country:US
Mailing Address - Phone:407-782-6703
Mailing Address - Fax:
Practice Address - Street 1:3200 CLEMENTS RD
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35453-2137
Practice Address - Country:US
Practice Address - Phone:205-752-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist