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NPI Code Detail

MEDICARE: MRS. LORI KRISTEN WHITWORTH OTR

MEDICARE: MRS. LORI KRISTEN WHITWORTH OTR
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 Therapist03187MD

General Provider Information

NPI Number : 1396015079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI KRISTEN WHITWORTH OTR
Provider Business Mailing Address
First Line : 5909 HANNA RD
Second Line :
City : ELDERSBURG
State : MD
Zip : 21784-6718
Country : US
Telephone Number : 410-795-2320
Fax Number : 410-549-2773
Provider Business Practice Location Address
First Line : 3000 N RIDGE RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-3311
Country : US
Telephone Number : 410-480-1547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 01/11/2012

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