Provider Demographics
NPI:1801257894
Name:MOMOT-HURST, MALGORZATA KRYSTYNA (MOT)
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:KRYSTYNA
Last Name:MOMOT-HURST
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2314
Mailing Address - Country:US
Mailing Address - Phone:617-785-8013
Mailing Address - Fax:
Practice Address - Street 1:307 INTERNATIONAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1387
Practice Address - Country:US
Practice Address - Phone:410-667-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist