Healthcare Provider Details

I. General information

NPI: 1225943202
Provider Name (Legal Business Name): MARRA SANDRA CROOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

4028 WILDWOOD WAY
ELLICOTT CITY MD
21042-5002
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10443
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: