Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225X00000X | Occupational Therapist | 09165 | MD |
NPI | 1003408261 |
---|---|
Provider Name | Bracha Mifsud |
First Address | Baltimore, MD 21209-2928 |
Second Address | Baltimore, MD 21215-3608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 22/06/2021 |