Provider Demographics
NPI:1851048854
Name:WOOLRIDGE, MYKIA
Entity Type:Individual
Prefix:
First Name:MYKIA
Middle Name:
Last Name:WOOLRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5353
Mailing Address - Country:US
Mailing Address - Phone:410-325-4000
Mailing Address - Fax:
Practice Address - Street 1:6319 BOSTON STREET
Practice Address - Street 2:BALTIMORE
Practice Address - City:MARYLAND
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:443-240-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant