Provider Demographics
NPI:1780704486
Name:IFILL, VENECIA CRISTAL (OT)
Entity type:Individual
Prefix:MISS
First Name:VENECIA
Middle Name:CRISTAL
Last Name:IFILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SADDLETOP CT APT A
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4046
Mailing Address - Country:US
Mailing Address - Phone:443-834-2858
Mailing Address - Fax:
Practice Address - Street 1:515 BRIGHTFIELD RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-3643
Practice Address - Country:US
Practice Address - Phone:410-832-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist