Healthcare Provider Details

I. General information

NPI: 1801753686
Provider Name (Legal Business Name): JHENELLE MAYNE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 TRIBECA TRL
LAUREL MD
20724-1445
US

IV. Provider business mailing address

3523 TRIBECA TRL
LAUREL MD
20724-1445
US

V. Phone/Fax

Practice location:
  • Phone: 561-287-0188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number10237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: