Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 07959 | MD |
NPI | 1023578747 |
---|---|
Provider Name | Keli Lyn Crosco |
First Address | Mt Lake Park, MD 21550-3502 |
Second Address | Oakland, MD 21550-3554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2019 |
Last Update Date | 20/03/2019 |