Individual
MRS. LEISA MARIE HIDEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
700 N. 40TH ST., BALTIMORE, MD 21211
(410) 235-8860
Mailing address
6203 WOODCREST DR., ELLICOTT CITY, MD 21043
(410) 379-0194
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A01399
MD
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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