Provider Demographics
NPI:1265139851
Name:AGBASI, AGNES ANANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:ANANE
Last Name:AGBASI
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 1:8540 OKEEFE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3136
Mailing Address - Country:US
Mailing Address - Phone:443-447-2827
Mailing Address - Fax:
Practice Address - Street 1:22 S ATHOL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3405
Practice Address - Country:US
Practice Address - Phone:443-447-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist