MEDICARE: JAVONNA FERGUSON

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	07267	MD

General Provider Information

NPI Number	:	1275067159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVONNA FERGUSON

Provider Business Mailing Address
First Line	:	9511 WHITEHURST DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 WHITEHURST DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4742
Country	:	US
Telephone Number	:	410-356-3246
Fax Number	:

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

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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Directions to “ JAVONNA FERGUSON ” Practice Location

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