Provider Demographics
NPI:1306391263
Name:WLODARCZYK, REBECCA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WLODARCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 KEATS TER
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9029
Mailing Address - Country:US
Mailing Address - Phone:301-363-8642
Mailing Address - Fax:
Practice Address - Street 1:347 BALLENGER CENTER DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7095
Practice Address - Country:US
Practice Address - Phone:301-663-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant