Provider Demographics
NPI:1154440634
Name:GOTTESMAN, HALI KUHR (OCCUPATIONAL THERAPT)
Entity type:Individual
Prefix:MRS
First Name:HALI
Middle Name:KUHR
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 WESTERN RUN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3117
Mailing Address - Country:US
Mailing Address - Phone:410-764-7913
Mailing Address - Fax:
Practice Address - Street 1:6609 WESTERN RUN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3117
Practice Address - Country:US
Practice Address - Phone:410-764-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ363HMOtherBLUE CROSS BLUE SHIELD
MD726503400Medicaid
MD463RMedicare ID - Type Unspecified
MD726503400Medicaid