Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1336592112 |
---|---|
Provider Name | Ms. Lauren King |
First Address | Baltimore, MD 21201-1642 |
Second Address | Baltimore, MD 21201-7912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2016 |
Last Update Date | 18/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05805 | STATE LICENSE (01) | MD |