Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 08545 | MD |
NPI | 1134681752 |
---|---|
Provider Name | Mrs. Radiatou Boucar |
First Address | Randallstown, MD 21133-1720 |
Second Address | Catonsville, MD 21228-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |