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General NPI Number Information
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NPI Number | 1043888977
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Entity Type | Individual
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Provider Name | RAIZEL PHETERSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 11 KELLER RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-1308
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Country | US
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Telephone | 410-415-5260
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Fax |
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Provider Business Mailing Address
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Address Line | 2318 BRIGHT LEAF WAY
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City | BALTIMORE
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State | MD
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Zip | 21209-3470
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Country | US
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Telephone | 443-760-7891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 09248
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License Number State | MD
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