Individual
SUPAK ANNE NGAMSNGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., OTR/L
Contact information
Practice address
1818 POT SPRING RD, SUITE 30, LUTHERVILLE, MD 21093-4445
(410) 583-5765
Mailing address
105 OSBORNE AVE, CATONSVILLE, MD 21228-4937
(410) 802-1216
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
05207
MD
Other
Enumeration date
02/21/2012
Last updated
02/21/2012
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