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General NPI Number Information
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NPI Number | 1588053227
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Entity Type | Organization
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Legal Business Name | ON TRACK REHABILITATION, LLC
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 8839 KELSO DR
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City | ESSEX
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State | MD
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Zip | 21221-3141
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Country | US
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Telephone | 443-415-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 3702 BRENBROOK DR
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4116
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Country | US
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Telephone | 443-415-0004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ERIN LATREACE LOGAN
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Credential | P.T.
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Telephone | 443-415-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 20878
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20878
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License Number State | MD
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