Basic Information
| Provider Information | |||||||||
| NPI: | 1356590079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHENE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | LLOYD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.O.T.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
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| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 907 GLOUSTER CIR | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210741697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103740419 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9637 LIBERTY RD STE K | ||||||||
| Address2: | |||||||||
| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211332452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109228600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A00568 | MD | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | A00568 | 01 | MD | LICENSE BOARD OF OCCUPATIONAL THERAPY | OTHER |