Provider Demographics
NPI:1649507609
Name:MCNAMARA, MARIE (OT/L)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12122A HERITAGE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4554
Mailing Address - Country:US
Mailing Address - Phone:301-942-6006
Mailing Address - Fax:
Practice Address - Street 1:12122A HERITAGE PARK CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4554
Practice Address - Country:US
Practice Address - Phone:301-942-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02363225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS958OtherBLUE CROSS BLUE SHIELD
MDA690PEOtherBLUE CROSS BLUE SHIELD