Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | 23025 | MD |
NPI | 1033885231 |
---|---|
Provider Name | Laura Jean Provost |
First Address | Annapolis, MD 21401-3209 |
Second Address | Baltimore, MD 21236-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |