Provider Demographics
NPI:1861374886
Name:CUBBAGE, PATTY R
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:R
Last Name:CUBBAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 BELMONT AVE STE 502B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4590
Mailing Address - Country:US
Mailing Address - Phone:410-546-2894
Mailing Address - Fax:
Practice Address - Street 1:1336 BELMONT AVE STE 502B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4590
Practice Address - Country:US
Practice Address - Phone:410-546-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT00461224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant