Organization
CPT, LLC
Active
Other names
Potomac Behavioral and Occupational Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY KENNELL (BILLING/CREDENTIALING MANAGER)
(301) 722-0616
Entity
Organization
Contact information
Practice address
249 HENDERSON AVE, CUMBERLAND, MD 21502-1638
(240) 362-7444
Mailing address
249 HENDERSON AVE, CUMBERLAND, MD 21502-1638
(240) 362-7444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240904600
—
MD
Enumeration date
04/20/2018
Last updated
06/16/2018
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