Provider Demographics
NPI:1073702825
Name:TOTALLY AWESOME TRANSPORTATION, INC
Entity Type:Organization
Organization Name:TOTALLY AWESOME TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-728-2507
Mailing Address - Street 1:13512 HOLLOW LOG DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4202
Mailing Address - Country:US
Mailing Address - Phone:301-209-8212
Mailing Address - Fax:301-209-8213
Practice Address - Street 1:13512 HOLLOW LOG DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4202
Practice Address - Country:US
Practice Address - Phone:301-209-8212
Practice Address - Fax:301-209-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCWMATC 1361343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)