Provider Demographics
NPI:1609069640
Name:EWELL, KATHRYN ALICE (MS ED, OTR/L, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ALICE
Last Name:EWELL
Suffix:
Gender:F
Credentials:MS ED, OTR/L, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9100
Mailing Address - Country:US
Mailing Address - Phone:410-935-9511
Mailing Address - Fax:
Practice Address - Street 1:526 BELFAST RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9100
Practice Address - Country:US
Practice Address - Phone:410-935-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05222225XP0200X
MD1-14-16374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics