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Individual

VICTORIA D ST.MIRE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
410 E MACPHAIL RD, BEL AIR, MD 21014-4410
(410) 879-1120
Mailing address
941 CUMMINGS AVE, BLACKWOOD, NJ 08012-4008
(856) 227-0036

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
46TA09100700
NJ
224Z00000X
Occupational Therapy Assistant
Primary
A02627
MD
224Z00000X
Occupational Therapy Assistant
OP009390
PA

Other

Enumeration date
08/31/2018
Last updated
08/31/2018
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