Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 08135 | MD |
NPI | 1013436195 |
---|---|
Provider Name | Miss Raven Daaku |
First Address | Camp Springs, MD 20746-4565 |
Second Address | Camp Springs, MD 20746-4565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 11/09/2017 |