Provider Demographics
NPI:1700052420
Name:THERAGRO, INC.
Entity Type:Organization
Organization Name:THERAGRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINDENSTRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:410-751-6800
Mailing Address - Street 1:1185 LARKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3363
Mailing Address - Country:US
Mailing Address - Phone:410-751-6800
Mailing Address - Fax:
Practice Address - Street 1:505 OLD WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6223
Practice Address - Country:US
Practice Address - Phone:410-751-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02915225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02915OtherOCCUPATIONAL THERAPIST LICENSE