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General NPI Number Information
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NPI Number | 1568677581
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Entity Type | Individual
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Provider Name | MARY PAT FASICK OTR
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Gender | Female
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 122 DEFENSE HWY 224
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7069
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Country | US
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Telephone | 410-864-8718
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Fax | 443-716-0415
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Provider Business Mailing Address
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Address Line | 14 GIDDINGS AVE
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City | SEVERNA PARK
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State | MD
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Zip | 21146-3308
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Country | US
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Telephone | 410-647-5596
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 05646
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License Number State | MD
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