Healthcare Provider Details

I. General information

NPI: 1992583652
Provider Name (Legal Business Name): KABRINA LATUAN HORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11974 EDGEHILL TERRACE RD
PRINCESS ANNE MD
21853-2105
US

IV. Provider business mailing address

3366 RESIDENTIAL DR
EDEN MD
21822-2233
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-0011
  • Fax:
Mailing address:
  • Phone: 443-359-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10076
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: