Provider Demographics
NPI:1568677581
Name:FASICK, MARY PAT (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:FASICK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:14 GIDDINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3308
Mailing Address - Country:US
Mailing Address - Phone:410-647-5596
Mailing Address - Fax:
Practice Address - Street 1:122 DEFENSE HWY
Practice Address - Street 2:224
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7069
Practice Address - Country:US
Practice Address - Phone:410-864-8718
Practice Address - Fax:443-716-0415
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05646225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics