Healthcare Provider Details

I. General information

NPI: 1073251229
Provider Name (Legal Business Name): BEVERLY UWANAKA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PERRY PKWY STE 1
GAITHERSBURG MD
20877-2144
US

IV. Provider business mailing address

211 PERRY PKWY STE 1
GAITHERSBURG MD
20877-2144
US

V. Phone/Fax

Practice location:
  • Phone: 301-916-8540
  • Fax:
Mailing address:
  • Phone: 301-916-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: