Provider Demographics
NPI:1013503325
Name:BORJA, MARIA MIKAELA VICERRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA MIKAELA
Middle Name:VICERRA
Last Name:BORJA
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 1:615 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3742
Mailing Address - Country:US
Mailing Address - Phone:410-825-7423
Mailing Address - Fax:
Practice Address - Street 1:3632 WILLOW ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1890
Practice Address - Country:US
Practice Address - Phone:443-540-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist