Provider Demographics
NPI:1134310238
Name:NORTHWEST O.T. ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHWEST O.T. ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:410-429-1906
Mailing Address - Street 1:15115 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:UPPERCO
Mailing Address - State:MD
Mailing Address - Zip Code:21155-9746
Mailing Address - Country:US
Mailing Address - Phone:410-429-1906
Mailing Address - Fax:
Practice Address - Street 1:15115 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:UPPERCO
Practice Address - State:MD
Practice Address - Zip Code:21155-9746
Practice Address - Country:US
Practice Address - Phone:410-429-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01516261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH888-0001OtherBLUE CHOICE
MDJ242OtherCAREFIRST BC/ BS