Basic Information
| Provider Information | |||||||||
| NPI: | 1003801614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURVITZ | ||||||||
| FirstName: | CHANA | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6237 BERKELEY AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106988804 | ||||||||
| FaxNumber: | 4107641493 | ||||||||
| Practice Location | |||||||||
| Address1: | 6237 BERKELEY AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106988804 | ||||||||
| FaxNumber: | 4107641493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 03365 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | K1590001 | 01 | MD | NATIONAL CAREFIRST PROVID | OTHER | 372B | 01 | MD | CAREFIRST BC/BS MD PROVID | OTHER |