Provider Demographics
NPI:1912148842
Name:MISURA, TODD ALAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALAN
Last Name:MISURA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 SMOKETREE RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3463
Mailing Address - Country:US
Mailing Address - Phone:301-741-1325
Mailing Address - Fax:
Practice Address - Street 1:12010 SMOKETREE RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3463
Practice Address - Country:US
Practice Address - Phone:301-741-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05695225XP0200X
DCOT010000394225XP0200X
VA0119004220225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
225XP0200XOtherINDEPENDENCE BLUE CROSS