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NPI Code Detail

MEDICARE: FORTUNATO IGNACIO OTR/L

MEDICARE:   FORTUNATO  IGNACIO  OTR/L
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
1225X00000XOccupational Therapist03782MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103782OTHERMDMARYLAND BOARD OF OCCUPATIONAL THERAPY

General Provider Information

NPI Number : 1245711324
Entity Type Code : Individual
Provider Name (Legal Business Name) : FORTUNATO IGNACIO OTR/L
Provider Business Mailing Address
First Line : 12021 LIVINGSTON RD
Second Line :
City : FORT WASHINGTON
State : MD
Zip : 20744-4210
Country : US
Telephone Number : 301-292-0600
Fax Number :
Provider Business Practice Location Address
First Line : 12021 LIVINGSTON RD
Second Line :
City : FT WASHINGTON
State : MD
Zip : 20744-4210
Country : US
Telephone Number : 301-292-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 08/27/2018

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Directions to “ FORTUNATO IGNACIO OTR/L” Practice Location

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