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General NPI Number Information
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NPI Number | 1194882159
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Entity Type | Individual
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Provider Name | TRAVIS ROBERT WYCOFF OTR ,L
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 412 MALCOLM DR SUITE 306
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City | WESTMINSTER
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State | MD
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Zip | 21157-6115
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Country | US
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Telephone | 410-876-0706
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Fax | 410-876-0131
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Provider Business Mailing Address
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Address Line | 5 SARA LN
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City | HANOVER
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State | PA
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Zip | 17331-8673
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Country | US
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Telephone | 717-637-6264
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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 | 05499
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License Number State | MD
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