Provider Demographics
NPI:1679294318
Name:THE REMOTE OT LLC
Entity type:Organization
Organization Name:THE REMOTE OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:MARIANNE
Authorized Official - Last Name:ENGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CFWE, OTR/L
Authorized Official - Phone:239-784-3931
Mailing Address - Street 1:5471 OLD COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3201
Mailing Address - Country:US
Mailing Address - Phone:239-784-3931
Mailing Address - Fax:
Practice Address - Street 1:5471 OLD COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3201
Practice Address - Country:US
Practice Address - Phone:239-784-3931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD205437000Medicaid