Provider Demographics
NPI:1003381120
Name:RIDGELL, AGNES
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:RIDGELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39608 LADY BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2534
Mailing Address - Country:US
Mailing Address - Phone:301-672-2579
Mailing Address - Fax:
Practice Address - Street 1:21585 PEABODY ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2955
Practice Address - Country:US
Practice Address - Phone:301-475-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3417034Medicaid