Provider Demographics
NPI:1336490408
Name:WHITTAKER, TRISHA A (OT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:A
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419666
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9666
Mailing Address - Country:US
Mailing Address - Phone:410-970-8190
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-856-4803
Practice Address - Fax:301-877-2366
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8825 - 0016OtherCAREFIRST