Provider Demographics
NPI:1932747094
Name:NGIDI-BROWN, JENNY (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:NGIDI-BROWN
Suffix:
Gender:F
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 1:8000 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21252-0002
Mailing Address - Country:US
Mailing Address - Phone:410-704-7300
Mailing Address - Fax:410-704-6303
Practice Address - Street 1:1 OLYMPIC PL STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4118
Practice Address - Country:US
Practice Address - Phone:410-704-7300
Practice Address - Fax:410-704-6303
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist