Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 18623 | MD |
NPI | 1346490992 |
---|---|
Provider Name | Ms. Marie Amabel Olo |
First Address | Columbia, MD 21046-1703 |
Second Address | Randallstown, MD 21133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 13/07/2011 |