Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 07873 | MD |
NPI | 1003388125 |
---|---|
Provider Name | Mrs. Cecilia Mahle |
First Address | Towson, MD 21204-6665 |
Second Address | Gwynn Oak, MD 21207-6665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2018 |
Last Update Date | 31/12/2018 |