Individual
TYLER V BOHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2225 OLD EMMORTON RD STE 210, BEL AIR, MD 21015-6123
(410) 515-4900
(410) 515-0777
Mailing address
3203 SPADE RD, WINDSOR MILL, MD 21244-3439
(410) 515-4900
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A02545
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419800000
—
MD
Enumeration date
02/27/2019
Last updated
02/27/2019
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