=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437477445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE HECOX MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2010
-----------------------------------------------------
Last Update Date | 02/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5963 EXCHANGE DR STE 109
-----------------------------------------------------
City | ELDERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-9256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-552-4044
-----------------------------------------------------
Fax | 410-552-4044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1940 VICTORY HILLS WAY
-----------------------------------------------------
City | MARRIOTTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21104-1169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-552-4044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 04966
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------