MEDICARE: WELLSPRING CHARITIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1134603251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING CHARITIES, INC

Provider Business Mailing Address
First Line	:	480 MARIANNA DR
Second Line	:
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-1820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 BAY RIDGE RD STE 180
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-3935
Country	:	US
Telephone Number	:	240-620-3028
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	THEMBI DEPASS
Credential	:
Telephone Number	:	240-495-1505

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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Directions to “WELLSPRING CHARITIES, INC ” Practice Location

Language	Start Address	Practice Location

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