Healthcare Provider Details

I. General information

NPI: 1689245508
Provider Name (Legal Business Name): WILLIAM HURST OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 2ND AVE
SYKESVILLE MD
21784-7531
US

IV. Provider business mailing address

128 PINE GROVE RD
HANOVER PA
17331-9013
US

V. Phone/Fax

Practice location:
  • Phone: 717-357-5624
  • Fax:
Mailing address:
  • Phone: 717-357-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number04591
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: