Basic Information
| Provider Information | |||||||||
| NPI: | 1679865943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | COLL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | OT, CHT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLL | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | OT, CHT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6914 HOLABIRD AVENUE | ||||||||
| Address2: | |||||||||
| City: | DUNDLAK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102845441 | ||||||||
| FaxNumber: | 4102845442 | ||||||||
| Practice Location | |||||||||
| Address1: | 6914 HOLABIRD AVE | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212221747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102845441 | ||||||||
| FaxNumber: | 4102845442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 05/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 02173 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.