Individual
MR. TRAVIS ROBERT WYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR ,L
Contact information
Practice address
412 MALCOLM DR, SUITE 306, WESTMINSTER, MD 21157-6115
(410) 876-0706
(410) 876-0131
Mailing address
5 SARA LN, HANOVER, PA 17331-8673
(717) 637-6264
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
05499
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023348001
—
MD
01
—
4761-0202
BLUECHOICE
MD
01
—
7005727
AETNA
MD
01
—
88398001
BCBS
MD
Enumeration date
01/02/2007
Last updated
07/09/2007
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