Provider Demographics
NPI:1700457876
Name:TOTAL ASSIST HOME THERAPY
Entity Type:Organization
Organization Name:TOTAL ASSIST HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:609-502-4322
Mailing Address - Street 1:5312 CHASE LIONS WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5596
Mailing Address - Country:US
Mailing Address - Phone:609-502-4322
Mailing Address - Fax:
Practice Address - Street 1:5312 CHASE LIONS WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-5596
Practice Address - Country:US
Practice Address - Phone:609-502-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty