Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 07220 | MD |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 07220 | MD |
NPI | 1093259475 |
---|---|
Provider Name | Krystle Rumbaugh |
First Address | Glen Burnie, MD 21061-3065 |
Second Address | Frederick, MD 21702-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 05/12/2016 |