Provider Demographics
NPI:1710255096
Name:ABRAHA, TIGISTI TESFAI (MD,OTR/L,CPAM)
Entity Type:Individual
Prefix:
First Name:TIGISTI
Middle Name:TESFAI
Last Name:ABRAHA
Suffix:
Gender:F
Credentials:MD,OTR/L,CPAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791217
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-2060
Mailing Address - Country:US
Mailing Address - Phone:301-932-4786
Mailing Address - Fax:301-932-4789
Practice Address - Street 1:7905 MALCOLM RD STE 201
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1749
Practice Address - Country:US
Practice Address - Phone:301-856-0050
Practice Address - Fax:301-856-0518
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06723225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand