Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 03742 | MD |
NPI | 1003031105 |
---|---|
Provider Name | Mrs. Regina Suggs Ernest |
First Address | Columbia, MD 21044-3609 |
Second Address | Takoma Park, MD 20912-6367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |