Healthcare Provider Details

I. General information

NPI: 1346373552
Provider Name (Legal Business Name): OLIVIA MARISA TIJERINA M.S.C.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3273
US

IV. Provider business mailing address

8512 ELLICOTT VIEW RD
ELLICOTT CITY MD
21043-6080
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-0300
  • Fax: 410-740-0302
Mailing address:
  • Phone: 410-461-5691
  • Fax: 410-560-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: