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General NPI Number Information
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NPI Number | 1316413222
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Entity Type | Organization
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Legal Business Name | PAIN & WELLNESS THERAPIES LLC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 2300 GARRISON BLVD STE 200
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City | BALTIMORE
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State | MD
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Zip | 21216-2309
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Country | US
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Telephone | 301-592-7642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | JESSUP
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State | MD
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Zip | 20794-0688
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LESLIE OGBEBOR
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Credential | AGACNP-BC
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Telephone | 301-592-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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