Carissa Joy Antezana, PTA
Individual provider Active NPI Occupational Therapy Assistant · Leonardtown, MD
NPI 1568060739 · NPPES record last updated Oct 11, 2020
Key facts
- NPI
- 1568060739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- A02694 (MD)
- Practice address
- 25480 Point Lookout Rd Ste 200
Leonardtown, MD 20650-3801 - Phone
- (240) 256-3711
- Fax
- (240) 256-3612
- NPI assigned
- Oct 11, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A02694 | MD | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | A02694 | MD | Yes |
Addresses
Primary practice location
25480 Point Lookout Rd Ste 200
Leonardtown, MD 20650-3801
Mailing address
25480 Point Lookout Rd Ste 200
Leonardtown, MD 20650-3801
Phone (240) 256-3711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4218604 | Medicaid | MD |
Other providers in Leonardtown, MD
- Alliance Anesthesia Associates, LLC
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- Amin and Strouth DDS PA
- Anesthesia Company, LLC
- Anne Arundel Dermatology, P.a.
- Ashraf Fanous, MD LLC
- Emmanuel A Atiemo
- Andrea Atlas
- Elorm Atuwo
- Sarah Avalos
All providers in Leonardtown, MD · Occupational Therapy Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.