MEDICARE: MARY E BLUM OT

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
1	225X00000X	Occupational Therapist	02190	MD

General Provider Information

NPI Number	:	1528334521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E BLUM OT

Provider Business Mailing Address
First Line	:	4617 LIVE OAK CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6717
Country	:	US
Telephone Number	:	410-236-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 LIVE OAK CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6717
Country	:	US
Telephone Number	:	410-236-9995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2012
Last Update Date	:	03/24/2012

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