Provider Demographics
NPI:1831205830
Name:OTREMBA-GORSKI, JENNIFER ROSE (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:OTREMBA-GORSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6606 LOCHINVAR DR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3416
Mailing Address - Country:US
Mailing Address - Phone:410-747-7788
Mailing Address - Fax:410-312-9001
Practice Address - Street 1:6300 WOODSIDE CT
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1098
Practice Address - Country:US
Practice Address - Phone:410-312-9000
Practice Address - Fax:410-312-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic