Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A01399 | MD |
NPI | 1003037136 |
---|---|
Provider Name | Mrs. Leisa Marie Hidey |
First Address | Ellicott City, MD 21043 |
Second Address | Baltimore, MD 21211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |