Healthcare Provider Details

I. General information

NPI: 1881724169
Provider Name (Legal Business Name): NEW BEGINNING PEDIATRIC REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 105/106
COLUMBIA MD
21045-1840
US

IV. Provider business mailing address

PO BOX 1343
CLARKSTON MI
48347-1343
US

V. Phone/Fax

Practice location:
  • Phone: 410-796-8499
  • Fax: 877-384-9028
Mailing address:
  • Phone: 410-796-8499
  • Fax: 877-384-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number05556
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06394
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number17389
License Number StateMD

VIII. Authorized Official

Name: MS. SHARI L MARCHESE-KENNEDY
Title or Position: PRESIDENT
Credential: MPT
Phone: 410-796-8499