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General NPI Number Information
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NPI Number | 1316516909
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Entity Type | Organization
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Legal Business Name | SPECIALTY PAIN MANAGEMENT SERVICES
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 8008 NIGHTWIND CT
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City | ELKRIDGE
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State | MD
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Zip | 21075-6463
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Country | US
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Telephone | 410-404-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 8008 NIGHTWIND CT
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City | ELKRIDGE
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State | MD
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Zip | 21075-6463
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Country | US
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Telephone | 410-404-6071
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MS. LYDIA BONGIORNI
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Credential | OTR/L
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Telephone | 443-472-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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