Healthcare Provider Details

I. General information

NPI: 1508783895
Provider Name (Legal Business Name): AMY LISS LISS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 SUGARCONE RD
BALTIMORE MD
21209-1030
US

IV. Provider business mailing address

2218 SUGARCONE RD
BALTIMORE MD
21209-1030
US

V. Phone/Fax

Practice location:
  • Phone: 410-970-7180
  • Fax: 410-970-7195
Mailing address:
  • Phone: 410-970-7180
  • Fax: 410-970-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05561
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: