Provider Demographics
NPI:1528591542
Name:HABTESELASIE, TSEHAYE
Entity Type:Individual
Prefix:
First Name:TSEHAYE
Middle Name:
Last Name:HABTESELASIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 CREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3525
Mailing Address - Country:US
Mailing Address - Phone:202-704-3278
Mailing Address - Fax:
Practice Address - Street 1:6451 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1010
Practice Address - Country:US
Practice Address - Phone:187-740-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist