Active NPI
Agnes Ridgell
- Occupational Therapist
- Leonardtown, MD
National Provider Identifier
1003381120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 21585 Peabody St
Leonardtown, MD 20650-2955 - Phone
- (301) 475-8000
- NPI assigned
- Oct 4, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
21585 Peabody St
Leonardtown, MD 20650-2955
Mailing address
39608 Lady Baltimore Ave
Leonardtown, MD 20650-2534
Phone (301) 672-2579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3417034 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538611200000",
"number": "1003381120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39608 LADY BALTIMORE AVE",
"city": "LEONARDTOWN",
"state": "MD",
"postal_code": "206502534",
"telephone_number": "301-672-2579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21585 PEABODY ST",
"city": "LEONARDTOWN",
"state": "MD",
"postal_code": "206502955",
"telephone_number": "301-475-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDGELL",
"first_name": "AGNES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-04",
"last_updated": "2018-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3417034",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leonardtown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.