Provider Demographics
NPI:1538449475
Name:RAKHMINOV, ELLADA (OT)
Entity type:Individual
Prefix:MRS
First Name:ELLADA
Middle Name:
Last Name:RAKHMINOV
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LA SALLE RD STE 335
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2009
Mailing Address - Country:US
Mailing Address - Phone:410-823-0880
Mailing Address - Fax:
Practice Address - Street 1:8600 LA SALLE RD STE 335
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2009
Practice Address - Country:US
Practice Address - Phone:410-823-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist