Provider Demographics
NPI:1083184998
Name:BLACKWELL, CATHY HARRIS (COTA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:HARRIS
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 QUEENS PARK DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2251
Mailing Address - Country:US
Mailing Address - Phone:410-654-7566
Mailing Address - Fax:
Practice Address - Street 1:515 BRIGHTFIELD RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-3643
Practice Address - Country:US
Practice Address - Phone:410-296-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02709224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant