# SOVEREIGNTY HEALTH SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487288635
- **Authorized official:** KEHINDE M TIJANI OTR/L (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (410) 940-1983

## Contact information

- **Practice address:** 1319 WOODBRIDGE STATION WAY UNIT 102, EDGEWOOD, MD 21040-3852
- **Practice address phone:** (410) 940-1983
- **Mailing address:** 152 SPECTATOR LN, OWINGS MILLS, MD 21117-4444
- **Mailing address phone:** (410) 940-1983

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 02/26/2020
- **Last updated:** 03/07/2020