Individual
MRS. CARISSA JOY ANTEZANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
25480 POINT LOOKOUT RD STE 200, LEONARDTOWN, MD 20650-3801
(240) 256-3711
(240) 256-3612
Mailing address
25480 POINT LOOKOUT RD STE 200, LEONARDTOWN, MD 20650-3801
(240) 256-3711
(240) 256-3612
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A02694
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4218604
—
MD
Enumeration date
10/11/2020
Last updated
10/11/2020
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