Provider Demographics
NPI:1912276072
Name:ALON, SORAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:SORAH
Middle Name:
Last Name:ALON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SCOTTS HILL DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3525
Mailing Address - Country:US
Mailing Address - Phone:410-602-0598
Mailing Address - Fax:866-840-6040
Practice Address - Street 1:1027 SCOTTS HILL DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3525
Practice Address - Country:US
Practice Address - Phone:410-484-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MDA01595224Z00000X
RBT-21-189682106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant