Provider Demographics
NPI:1992898407
Name:TRENT, TERRELL (OTR/L)
Entity type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:
Last Name:TRENT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HOLLINS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1004
Mailing Address - Country:US
Mailing Address - Phone:202-409-9895
Mailing Address - Fax:
Practice Address - Street 1:3939 PENHURST AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5632
Practice Address - Country:US
Practice Address - Phone:202-409-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400245800Medicaid
MDJ381PROtherBLUECROSSBLUESHIELD
MDJ381PROtherBLUECROSSBLUESHIELD