MEDICARE: CRADDLES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225100000X	Physical Therapist
3	225200000X	Physical Therapy Assistant
4	235Z00000X	Speech-Language Pathologist
5	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1821620758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRADDLES LLC

Provider Business Mailing Address
First Line	:	5310 OLD COURT RD STE 303
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-6202
Country	:	US
Telephone Number	:	443-857-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 WOODBRIDGE STATION WAY STE 102
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-3852
Country	:	US
Telephone Number	:	443-857-7475
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHAKIRAT OLABISI AROWOROWON
Credential	:	COTA/L
Telephone Number	:	443-857-7475

Provider Enumeration Date	:	02/09/2020
Last Update Date	:	02/09/2020

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Directions to “CRADDLES LLC ” Practice Location

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