Basic Information
| Provider Information | |||||||||
| NPI: | 1346490992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLO | ||||||||
| FirstName: | MARIE AMABEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10015 OLD COLUMBIA RD | ||||||||
| Address2: | SUITE B-215 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103566161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9637 LIBERTY ROAD | ||||||||
| Address2: | SUITE K | ||||||||
| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103566161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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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 | 2251G0304X | 18623 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.