Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 03433 | MD |
NPI | 1154589752 |
---|---|
Provider Name | Mrs. Rachel Virginia Johnson |
First Address | Baltimore, MD 21224-2409 |
Second Address | Baltimore, MD 21224-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 30/05/2008 |