Healthcare Provider Details

I. General information

NPI: 1447503875
Provider Name (Legal Business Name): MELISSA KEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DULANEY VALLEY RD
LUTHERVILLE MD
21093-2739
US

IV. Provider business mailing address

1508 BALDWIN MILL RD
JARRETTSVILLE MD
21084-1902
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number06966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: