Healthcare Provider Details

I. General information

NPI: 1770670119
Provider Name (Legal Business Name): MARYCLAIRE ELIZABETH MACLAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 80H, ROOM 201
PERRY POINT MD
21902
US

IV. Provider business mailing address

700 OAKWOOD ROAD
ABERDEEN MD
21001
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1897
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: