Provider Demographics
NPI:1043337827
Name:KUTNEY, ELAINE (OTA)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KUTNEY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:HOLLENBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:402 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1531
Mailing Address - Country:US
Mailing Address - Phone:410-515-0375
Mailing Address - Fax:
Practice Address - Street 1:9200 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4458
Practice Address - Country:US
Practice Address - Phone:410-391-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00096224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant