Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | T01178 | MD |
NPI | 1003302357 |
---|---|
Provider Name | Rahna Shahrokh |
First Address | Highland, MD 20777-9611 |
Second Address | Westminster, MD 21157-5726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |