Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 06828 | MD |
NPI | 1386057396 |
---|---|
Provider Name | Ma Pamela Borden |
First Address | Hagerstown, MD 21742 |
Second Address | Hagerstown, MD 21742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 06/06/2014 |