Provider Demographics
NPI:1336125566
Name:TRISTATE HAND AND OCCUPATIONAL THERAPY INC
Entity Type:Organization
Organization Name:TRISTATE HAND AND OCCUPATIONAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WODASKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR L CHT
Authorized Official - Phone:301-759-4263
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1517
Mailing Address - Country:US
Mailing Address - Phone:301-759-4263
Mailing Address - Fax:301-759-4461
Practice Address - Street 1:200 GLENN ST
Practice Address - Street 2:STE 200
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2436
Practice Address - Country:US
Practice Address - Phone:301-759-4263
Practice Address - Fax:301-759-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD834200801Medicaid
MDLN87TROtherCALEFIRST
6637055 001OtherCIGNA PPO HMO
MDR689OtherCALEFIRST
271417OtherMAMSI MDIPA OPTIMUM CHOIC
64 00216OtherUNC MID ATLANTIC
WV1045607OtherWORKERS COMP
VA215904OtherTRIGON ANTHEM
1755801OtherUHC
WV3810001817Medicaid
MDN0336OtherWORKERS COMP
MDN0336OtherWORKERS COMP
MDR689OtherCALEFIRST
MD=========OtherCHAMP VA
271417OtherMAMSI MDIPA OPTIMUM CHOIC
VA215904OtherTRIGON ANTHEM
732MMedicare PIN