Healthcare Provider Details

I. General information

NPI: 1568945046
Provider Name (Legal Business Name): TYRONE BANKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HURLEY AVE
ROCKVILLE MD
20850-3118
US

IV. Provider business mailing address

904 SANGERVILLE CIR
UPPER MARLBORO MD
20774-8434
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: