Provider Demographics
NPI:1992995237
Name:ELLERBE, TERRI REDD (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:REDD
Last Name:ELLERBE
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15208 RICHARD BOWIE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9247
Mailing Address - Country:US
Mailing Address - Phone:202-258-5455
Mailing Address - Fax:
Practice Address - Street 1:15208 RICHARD BOWIE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-9247
Practice Address - Country:US
Practice Address - Phone:202-258-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05941225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist