Provider Demographics
NPI:1639353790
Name:BROWN-DICOSTANTINO, LIZA A (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:A
Last Name:BROWN-DICOSTANTINO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BALTIMORE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3852
Mailing Address - Country:US
Mailing Address - Phone:443-618-4143
Mailing Address - Fax:
Practice Address - Street 1:213 BALTIMORE AVE SW
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3852
Practice Address - Country:US
Practice Address - Phone:443-618-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid