MEDICARE: JUDITH R SHEILDS

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	225XP0200X	Pediatric Occupational Therapist	03286	MD

General Provider Information

NPI Number	:	1235409269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH R SHEILDS

Provider Business Mailing Address
First Line	:	3608 BANCROFT RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6414 PARK HEIGHTS AVE APT T1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3073
Country	:	US
Telephone Number	:	410-358-1997
Fax Number	:	866-840-6040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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