Provider Demographics
NPI:1578945895
Name:SONIREGUN, MARY ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:SONIREGUN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ROSE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:800 S FREDERICK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4151
Mailing Address - Country:US
Mailing Address - Phone:240-200-5305
Mailing Address - Fax:
Practice Address - Street 1:800 S FREDERICK AVE STE 101
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4151
Practice Address - Country:US
Practice Address - Phone:240-200-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013911225X00000X
MD08151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist