Provider Demographics
NPI:1316516909
Name:SPECIALTY PAIN MANAGEMENT SERVICES
Entity type:Organization
Organization Name:SPECIALTY PAIN MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONGIORNI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:443-472-2449
Mailing Address - Street 1:8008 NIGHTWIND CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6463
Mailing Address - Country:US
Mailing Address - Phone:410-404-6071
Mailing Address - Fax:
Practice Address - Street 1:8008 NIGHTWIND CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6463
Practice Address - Country:US
Practice Address - Phone:410-404-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty