Healthcare Provider Details

I. General information

NPI: 1285089953
Provider Name (Legal Business Name): SHIRA KAHN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 POT SPRING RD
LUTHERVILLE MD
21093-2778
US

IV. Provider business mailing address

2525 POT SPRING RD
LUTHERVILLE MD
21093-2778
US

V. Phone/Fax

Practice location:
  • Phone: 410-561-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number07652
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: