Organization
NORTHWEST O.T. ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE WILSON MS, OTR/L (OWNER)
(410) 429-1906
Entity
Organization
Contact information
Practice address
15115 EASTVIEW DR, UPPERCO, MD 21155-9746
(410) 429-1906
Mailing address
15115 EASTVIEW DR, UPPERCO, MD 21155-9746
(410) 429-1906
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
01516
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H888-0001
BLUE CHOICE
MD
01
—
J242
CAREFIRST BC/ BS
MD
Enumeration date
08/05/2007
Last updated
08/05/2007
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