Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 05747 | MD |
NPI | 1003164856 |
---|---|
Provider Name | Miss Maria Isabelita Parane Tibon |
First Address | Potomac, MD 20854 |
Second Address | Potomac, MD 20854-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2012 |
Last Update Date | 28/08/2012 |