Provider Demographics
NPI:1407539091
Name:JALLOH, MARIAM (COTA)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:JALLOH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:JALLOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:4303 TURF FIELD CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5831
Mailing Address - Country:US
Mailing Address - Phone:703-475-4340
Mailing Address - Fax:
Practice Address - Street 1:6710 MALLERY DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3964
Practice Address - Country:US
Practice Address - Phone:301-552-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA03119224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant