Healthcare Provider Details

I. General information

NPI: 1396207510
Provider Name (Legal Business Name): MARGARET MARY HITZGES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 BOUNDARY AVE
ROCK HALL MD
21661-1604
US

IV. Provider business mailing address

5608 BOUNDARY AVE
ROCK HALL MD
21661-1604
US

V. Phone/Fax

Practice location:
  • Phone: 443-350-6501
  • Fax:
Mailing address:
  • Phone: 443-350-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number05227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: