Provider Demographics
NPI:1255475000
Name:SEFCOVIC, ANGELA DENISE (MS, OTRL)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:DENISE
Last Name:SEFCOVIC
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HERRING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-4018
Mailing Address - Country:US
Mailing Address - Phone:301-912-3249
Mailing Address - Fax:
Practice Address - Street 1:200 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7760
Practice Address - Country:US
Practice Address - Phone:410-222-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05744225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics