Individual
WALTER LARRY JASEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2327 N CHARLES ST, BALTIMORE, MD 21218-5128
(443) 220-4583
Mailing address
18633 OUTPOST RD, KEEDYSVILLE, MD 21756-1825
(443) 220-4583
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A00816
MD
Other
Enumeration date
02/23/2023
Last updated
02/23/2023
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