Provider Demographics
NPI:1124445317
Name:MUSGRAVE, KERRY
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3931
Mailing Address - Country:US
Mailing Address - Phone:410-544-2500
Mailing Address - Fax:844-868-4092
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3931
Practice Address - Country:US
Practice Address - Phone:410-544-2500
Practice Address - Fax:844-868-4092
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07308225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist