Basic Information
| Provider Information | |||||||||
| NPI: | 1770047763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRENARY | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30845 WARD RD | ||||||||
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| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218042753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107138745 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Practice Location | |||||||||
| Address1: | 7355 E FURNACE BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210607060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107663460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 16944 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.