Basic Information
| Provider Information | |||||||||
| NPI: | 1306391263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WLODARCZYK | ||||||||
| FirstName: | REBECCA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3402 KEATS TER | ||||||||
| Address2: | |||||||||
| City: | IJAMSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217549029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013638642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 347 BALLENGER CENTER DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217037095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016635181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2016 | ||||||||
| LastUpdateDate: | 08/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | A02369 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.