Active NPI
Gretchen Vidergar, OT
- Occupational Therapist
- Mitchellville, MD
National Provider Identifier
1487717690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 03340
- Practice address
- 12140 Central Ave
Mitchellville, MD 20721-1932 - Phone
- (301) 581-8054
- Fax
- (301) 564-0284
- NPI assigned
- Dec 18, 2006
- 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 | 03340 | MD | Primary |
Addresses
Primary practice location
12140 Central Ave
Mitchellville, MD 20721-1932
Mailing address
6410 Rockledge Dr
NRH Regional Rehab - Suite 600
Bethesda, MD 20817-1809
Phone (301) 581-8054
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03340 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487717690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6410 ROCKLEDGE DR",
"address_2": "NRH REGIONAL REHAB - SUITE 600",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208171809",
"telephone_number": "301-581-8054",
"fax_number": "301-564-0284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12140 CENTRAL AVE",
"city": "MITCHELLVILLE",
"state": "MD",
"postal_code": "207211932",
"telephone_number": "301-581-8054",
"fax_number": "301-564-0284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDERGAR",
"first_name": "GRETCHEN",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "03340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mitchellville, MD
- Trebor Alzheimer'S and Senior Support Center, LLC
- Trinity Wholistic Healing Services
- Ruth Tumushabe
- Titilayo Adenike Unegbu
- Revia Michelle Veney, CRNP
- Villa Rosa Nursing and Rehabilitation Center LLC
- Villa Rosa Nursing and Rehabilitation Center LLC
- Villa Rosa Nursing Home
- Tonya Renee Wade, RN
- Vanessa R Warner, PT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.