Healthcare Provider Details

I. General information

NPI: 1427195593
Provider Name (Legal Business Name): KUZHILETHU K. KSHEPAKARAN OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10999 RED RUN BLVD STE 112
OWINGS MILLS MD
21117-3263
US

IV. Provider business mailing address

2008 HUNTING RIDGE DR
OWINGS MILLS MD
21117-5051
US

V. Phone/Fax

Practice location:
  • Phone: 443-838-5973
  • Fax:
Mailing address:
  • Phone: 443-838-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01542
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: