Healthcare Provider Details

I. General information

NPI: 1629774575
Provider Name (Legal Business Name): MAYA COOPER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14995 SHADY GROVE RD STE 350
ROCKVILLE MD
20850-8726
US

IV. Provider business mailing address

14995 SHADY GROVE RD STE 350
ROCKVILLE MD
20850-8726
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-1433
  • Fax: 301-424-5266
Mailing address:
  • Phone: 301-251-1433
  • Fax: 301-424-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09848
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number09848
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: