Provider Demographics
NPI:1831143999
Name:STEVENS, LIND G (OTR)
Entity Type:Individual
Prefix:MS
First Name:LIND
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 LITTLE PATUXENT PKWY
Mailing Address - Street 2:APT 708
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3773
Mailing Address - Country:US
Mailing Address - Phone:301-642-2651
Mailing Address - Fax:443-798-2922
Practice Address - Street 1:11440 LITTLE PATUXENT PKWY
Practice Address - Street 2:APT 708
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3773
Practice Address - Country:US
Practice Address - Phone:443-798-2930
Practice Address - Fax:443-798-2922
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113142225X00000X
DCOT010000496225X00000X
VA0119004256225X00000X
MD01162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280818001Medicaid
TX280818002Medicaid
TX280818001Medicaid
TX8L20391Medicare PIN
TX8L20391Medicare PIN