Healthcare Provider Details

I. General information

NPI: 1295154334
Provider Name (Legal Business Name): LEAH SPOELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 BOILING BROOK PKWY
ROCKVILLE MD
20852-2300
US

IV. Provider business mailing address

PO BOX 37687
BALTIMORE MD
21297-3687
US

V. Phone/Fax

Practice location:
  • Phone: 301-816-9500
  • Fax: 301-668-7008
Mailing address:
  • Phone: 240-575-6983
  • Fax: 301-668-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number07362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: