Healthcare Provider Details

I. General information

NPI: 1639997059
Provider Name (Legal Business Name): SOPHIE NYCE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIE HANENFELD OT

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 410-677-0700
  • Fax: 410-677-0883
Mailing address:
  • Phone: 410-831-3226
  • Fax: 410-572-4041

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: