Provider Demographics
NPI:1053871475
Name:EDWARDS, VANITHA JASMINE (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:VANITHA
Middle Name:JASMINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:VANITHA
Other - Middle Name:JASMINE
Other - Last Name:JOHN THILAGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:5923 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5059
Mailing Address - Country:US
Mailing Address - Phone:443-939-1659
Mailing Address - Fax:
Practice Address - Street 1:200 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4888
Practice Address - Country:US
Practice Address - Phone:443-984-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist