Provider Demographics
NPI:1073251229
Name:UWANAKA, BEVERLY (OT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:UWANAKA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PERRY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2144
Mailing Address - Country:US
Mailing Address - Phone:301-916-8540
Mailing Address - Fax:
Practice Address - Street 1:211 PERRY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2144
Practice Address - Country:US
Practice Address - Phone:301-916-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist