Healthcare Provider Details

I. General information

NPI: 1336529502
Provider Name (Legal Business Name): LOW VISION OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 LITTLE PATUXENT PKWY APT 708
COLUMBIA MD
21044-3773
US

IV. Provider business mailing address

11440 LITTLE PATUXENT PKWY APT 708
COLUMBIA MD
21044-3773
US

V. Phone/Fax

Practice location:
  • Phone: 443-798-2930
  • Fax: 443-798-2922
Mailing address:
  • Phone: 443-798-2930
  • Fax: 443-798-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01162
License Number StateMD

VIII. Authorized Official

Name: MS. LIND G STEVENS
Title or Position: OCCUPATIONAL THERAPIST, OWNER
Credential: OTR/L, SCLV, MS
Phone: 443-798-2930