Individual
FORTUNATO IGNACIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
12021 LIVINGSTON RD, FT WASHINGTON, MD 20744-4210
(301) 292-0300
Mailing address
12021 LIVINGSTON RD, FORT WASHINGTON, MD 20744-4210
(301) 292-0600
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
03782
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03782
MARYLAND BOARD OF OCCUPATIONAL THERAPY
MD
Enumeration date
08/27/2018
Last updated
08/27/2018
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