=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912323775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHONA ADLEBERG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2014
-----------------------------------------------------
Last Update Date | 03/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8100 SANDPIPER CIR STE 104
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-370-9903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8100 SANDPIPER CIR STE 104
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 103-709-9034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 02366
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------