1336125566 NPI number — TRISTATE HAND AND OCCUPATIONAL THERAPY INC

Table of content: (NPI 1336125566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336125566 NPI number — TRISTATE HAND AND OCCUPATIONAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRISTATE HAND AND OCCUPATIONAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336125566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21501-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-759-4263
Provider Business Mailing Address Fax Number:
301-759-4461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GLENN ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-759-4263
Provider Business Practice Location Address Fax Number:
301-759-4461
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WODASKI
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-759-4263

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 834200801 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LN87TR . This is a "CALEFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6637055 001 . This is a "CIGNA PPO HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: R689 . This is a "CALEFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 271417 . This is a "MAMSI MDIPA OPTIMUM CHOIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64 00216 . This is a "UNC MID ATLANTIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1045607 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 215904 . This is a "TRIGON ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1755801 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810001817 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: N0336 . This is a "WORKERS COMP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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