Healthcare Provider Details

I. General information

NPI: 1396890224
Provider Name (Legal Business Name): ELIZABETH SNEAD BRAZIL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROCKVILLE PIKE STE 200
ROCKVILLE MD
20852-6426
US

IV. Provider business mailing address

1401 ROCKVILLE PIKE STE 200
ROCKVILLE MD
20852-6426
US

V. Phone/Fax

Practice location:
  • Phone: 301-802-4197
  • Fax:
Mailing address:
  • Phone: 301-802-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number04362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: