Healthcare Provider Details

I. General information

NPI: 1700078151
Provider Name (Legal Business Name): COUNTY THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 WHITEFORD RD
WHITEFORD MD
21160-1404
US

IV. Provider business mailing address

PO BOX 169
WHITEFORD MD
21160-0169
US

V. Phone/Fax

Practice location:
  • Phone: 410-452-8815
  • Fax: 410-452-8815
Mailing address:
  • Phone: 410-452-8815
  • Fax: 410-452-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02270
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MARY PATRICIA MATEJKA
Title or Position: OWNER/THERAPIST
Credential:
Phone: 410-452-8815