MEDICARE: SOVEREIGNTY HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1487288635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOVEREIGNTY HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	152 SPECTATOR LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4444
Country	:	US
Telephone Number	:	410-940-1983
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 WOODBRIDGE STATION WAY UNIT 102
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-3852
Country	:	US
Telephone Number	:	410-940-1983
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	KEHINDE M TIJANI
Credential	:	OTR/L
Telephone Number	:	410-940-1983

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	03/07/2020

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Directions to “SOVEREIGNTY HEALTH SERVICES LLC ” Practice Location

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