Provider Demographics
NPI:1760792378
Name:UMSTOT, VICKY LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:UMSTOT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 WESTERNPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562
Mailing Address - Country:US
Mailing Address - Phone:301-786-4171
Mailing Address - Fax:301-786-4203
Practice Address - Street 1:21907 WESTERNPORT ROAD
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562
Practice Address - Country:US
Practice Address - Phone:301-786-4171
Practice Address - Fax:301-786-4203
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06590225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist