Provider Demographics
NPI:1477826592
Name:NGAMSNGA, SUPAK ANNE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SUPAK
Middle Name:ANNE
Last Name:NGAMSNGA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OSBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4937
Mailing Address - Country:US
Mailing Address - Phone:410-802-1216
Mailing Address - Fax:
Practice Address - Street 1:1818 POT SPRING RD
Practice Address - Street 2:SUITE 30
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4445
Practice Address - Country:US
Practice Address - Phone:410-583-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05207225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics