Provider Demographics
NPI:1699957209
Name:DRUMMOND, CARLA WILBURN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:WILBURN
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:WILBURN
Other - Last Name:HANOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5900 METRO DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3207
Mailing Address - Country:US
Mailing Address - Phone:410-318-6780
Mailing Address - Fax:410-318-6759
Practice Address - Street 1:5900 METRO DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3207
Practice Address - Country:US
Practice Address - Phone:410-318-6780
Practice Address - Fax:410-318-6759
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01456225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD545400-03OtherCAREFIRST BCBS
MD545400-01OtherCAREFIRST BCBS
MD545400-02OtherCAREFIRST BCBS
DCJ175-0018OtherCAREFIRST BCBS