Healthcare Provider Details

I. General information

NPI: 1457025736
Provider Name (Legal Business Name): MAHIMA DHUMAK ORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 BRIGHTSEAT RD
LANDOVER MD
20785-3738
US

IV. Provider business mailing address

8028 RITCHIE HWY
PASADENA MD
21122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 240-487-4400
  • Fax:
Mailing address:
  • Phone: 410-766-1995
  • Fax: 410-761-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number80211
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: