Healthcare Provider Details

I. General information

NPI: 1932730488
Provider Name (Legal Business Name): ANNERI JAZMIN MADURO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
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

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-1433
  • Fax:
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-220-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: