Healthcare Provider Details

I. General information

NPI: 1518370824
Provider Name (Legal Business Name): DEANNE MEA ESGUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 NORMAN DRIVE APT 102
ANNAPOLIS MD
21403-3016
US

IV. Provider business mailing address

1065 NORMAN DRIVE APT 102
ANNAPOLIS MD
21403-3016
US

V. Phone/Fax

Practice location:
  • Phone: 240-401-2122
  • Fax:
Mailing address:
  • Phone: 240-401-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07286
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: