Provider Demographics
NPI:1780159483
Name:PREMATTA, ALISON MARIE
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:PREMATTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 CAVES RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2325
Mailing Address - Country:US
Mailing Address - Phone:443-791-4700
Mailing Address - Fax:
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2025-03-05
Deactivation Date:2025-02-18
Deactivation Code:
Reactivation Date:2025-03-03
Provider Licenses
StateLicense IDTaxonomies
MD409240224Z00000X
MD521164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant