Provider Demographics
NPI:1467164855
Name:ROOTED BEGINNINGS LLC
Entity Type:Organization
Organization Name:ROOTED BEGINNINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISETA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:240-242-5023
Mailing Address - Street 1:5384 SMOOTH MEADOW WAY UNIT 24
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1869
Mailing Address - Country:US
Mailing Address - Phone:240-242-5023
Mailing Address - Fax:
Practice Address - Street 1:5384 SMOOTH MEADOW WAY UNIT 24
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1869
Practice Address - Country:US
Practice Address - Phone:240-242-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty