Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A01741 | MD |
NPI | 1013209832 |
---|---|
Provider Name | Miss Chizarra Lateefah Dashiell |
First Address | Baltimore, MD 21207-4605 |
Second Address | Haverford, PA 19041-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |