Provider Demographics
NPI:1245361419
Name:DUDEK, JULIANNA LYNETTE (OTRL)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:LYNETTE
Last Name:DUDEK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:LYNETTE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:1241 LONG CORNER ROAD
Mailing Address - Street 2:
Mailing Address - City:MT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771
Mailing Address - Country:US
Mailing Address - Phone:301-831-5132
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6123
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:410-515-0777
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid