Provider Demographics
NPI:1326518234
Name:DYNAMIC OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:DYNAMIC OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-579-7155
Mailing Address - Street 1:10 N JEFFERSON ST STE 403
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4823
Mailing Address - Country:US
Mailing Address - Phone:301-668-1852
Mailing Address - Fax:301-668-1854
Practice Address - Street 1:10 N JEFFERSON ST STE 403
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4823
Practice Address - Country:US
Practice Address - Phone:301-668-1852
Practice Address - Fax:301-668-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty