MEDICARE: CASEY NATHAN

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

General Provider Information

NPI Number	:	1376322123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY NATHAN

Provider Business Mailing Address
First Line	:	1655 CROFTON BLVD STE 103
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1342
Country	:	US
Telephone Number	:	410-451-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 CROFTON BLVD STE 103
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1342
Country	:	US
Telephone Number	:	410-451-5700
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ CASEY NATHAN ” Practice Location

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