Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 05667 | MD |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 05667 | MD |
NPI | 1063900397 |
---|---|
Provider Name | Jody Fitch |
First Address | Westminster, MD 21157-5827 |
Second Address | Westminster, MD 21157-5827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 23/04/2018 |