Provider Demographics
NPI:1669100558
Name:OCCUPATIONAL THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:OCCUPATIONAL THERAPY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:443-212-8363
Mailing Address - Street 1:7609 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7348
Mailing Address - Country:US
Mailing Address - Phone:443-212-8363
Mailing Address - Fax:
Practice Address - Street 1:7609 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7348
Practice Address - Country:US
Practice Address - Phone:443-212-8363
Practice Address - Fax:410-705-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5192241600Medicaid