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NPI Code Detail

MEDICARE: MRS. RADIATOU BOUCAR OTR

MEDICARE: MRS. RADIATOU BOUCAR OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0019XPhysical Rehabilitation Occupational Therapist08545MD

General Provider Information

NPI Number : 1134681752
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RADIATOU BOUCAR OTR
Provider Business Mailing Address
First Line : 37 OJIBWAY RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-1720
Country : US
Telephone Number : 410-900-8223
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N ROLLING RD
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1100
Country : US
Telephone Number : 410-402-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2019
Last Update Date : 04/02/2019

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