Provider Demographics
NPI:1972624930
Name:DISNEY, LINDA JEAN (COTA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:DISNEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PLEASANT MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2651
Mailing Address - Country:US
Mailing Address - Phone:410-451-1249
Mailing Address - Fax:
Practice Address - Street 1:24 TRUCK HOUSE RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2715
Practice Address - Country:US
Practice Address - Phone:410-544-4220
Practice Address - Fax:410-647-9484
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01610224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant