Healthcare Provider Details

I. General information

NPI: 1528004298
Provider Name (Legal Business Name): GREGORY HENDERSON O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N CAPITOL ST NW
WASHINGTON DC
20011-8400
US

IV. Provider business mailing address

9013 WIPKEY CT
BOWIE MD
20720-3232
US

V. Phone/Fax

Practice location:
  • Phone: 800-422-9988
  • Fax: 301-262-1259
Mailing address:
  • Phone: 301-802-5309
  • Fax: 301-262-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: