Organization
3330 WILKENS AVENUE OPERATIONS LLC
Active
Other names
Caton Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
3330 WILKENS AVE, BALTIMORE, MD 21229-4610
(410) 525-1544
Mailing address
3330 WILKENS AVE, BALTIMORE, MD 21229-4610
(410) 525-1544
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
30008
MD
225X00000X
Occupational Therapist
30008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330009900
—
MD
Enumeration date
04/20/2016
Last updated
08/31/2017
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