Individual
JASON COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14409 GREENVIEW DR STE 102, LAUREL, MD 20708-4213
(301) 498-8100
(301) 498-0009
Mailing address
14409 GREENVIEW DR STE 102, LAUREL, MD 20708-4213
(301) 498-8100
(301) 498-0009
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A00514
MD
Other
Enumeration date
06/08/2007
Last updated
07/08/2007
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