Healthcare Provider Details

I. General information

NPI: 1831871052
Provider Name (Legal Business Name): MYASIA PRICE-CLEARE MOT, OT/LT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARLIAMENT PL # 550
LANHAM MD
20706-1849
US

IV. Provider business mailing address

4117 WARNER AVE APT C8
HYATTSVILLE MD
20784-1955
US

V. Phone/Fax

Practice location:
  • Phone: 240-245-4370
  • Fax:
Mailing address:
  • Phone: 804-714-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberT01252
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: