Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 06748 | MD |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 06748 | MD |
NPI | 1275070609 |
---|---|
Provider Name | Stacey A Harcum |
First Address | Towson, MD 21286-5901 |
Second Address | Gwynn Oak, MD 21207-6665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |