Basic Information
| Provider Information | |||||||||
| NPI: | 1447880406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLSON | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| OtherLastName: | BRIGHT | ||||||||
| OtherFirstName: | ADRIENNE | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2423 VINEYARD LN | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211141138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018038513 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12158 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | MITCHELLVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207211932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014302700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2020 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 08405 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.