Provider Demographics
NPI:1588020473
Name:LITTLE, ROBERTA JO
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JO
Last Name:LITTLE
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 1:15929 HANOVER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPERCO
Mailing Address - State:MD
Mailing Address - Zip Code:21155-9703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 TUC RD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5086
Practice Address - Country:US
Practice Address - Phone:410-871-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist