Healthcare Provider Details

I. General information

NPI: 1710422332
Provider Name (Legal Business Name): YASMIN ATTIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 08/30/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 ANNAPOLIS RD STE C
ODENTON MD
21113-1398
US

IV. Provider business mailing address

11922 TWINLAKES DR APT 26
BELTSVILLE MD
20705-6104
US

V. Phone/Fax

Practice location:
  • Phone: 410-305-4837
  • Fax:
Mailing address:
  • Phone: 610-804-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT200001240
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017422
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: