Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023501202 |
---|---|
Provider Name | Mrs. Collette E Ogbeiwi |
First Address | Baltimore, MD 21212-0022 |
Second Address | Baltimore, MD 21212-0022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185BF9K9 | (05) | MD |