Provider Demographics
NPI:1336986090
Name:SANDOVAL, GENESIS EMILIA (OTD)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:EMILIA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4516
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-646-3623
Practice Address - Street 1:910 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-646-3623
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist