Provider Demographics
NPI:1972664001
Name:PITTAWAY, MYRNA COCKRELL (OTRL)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:COCKRELL
Last Name:PITTAWAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:C
Other - Last Name:PITTAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:27 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1603
Mailing Address - Country:US
Mailing Address - Phone:571-201-9011
Mailing Address - Fax:
Practice Address - Street 1:801 N BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1424
Practice Address - Country:US
Practice Address - Phone:443-923-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05707225X00000X
VA019001965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist