Provider Demographics
NPI:1881143766
Name:ATIGHECHI, AZADEH (OT)
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:ATIGHECHI
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 1:1218 LAUREL OAK LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-9676
Mailing Address - Country:US
Mailing Address - Phone:410-704-7300
Mailing Address - Fax:410-704-6303
Practice Address - Street 1:1 OLYMPIC PL
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4104
Practice Address - Country:US
Practice Address - Phone:410-704-7300
Practice Address - Fax:410-704-6303
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist