21D2299754 CLIA NUMBER - HEADWATERS RESTORATION THERAPY

Laboratory Demographics

  • CLIA Code: 21D2299754
  • Facility Name: HEADWATERS RESTORATION THERAPY
  • Facility Address: 4000 THAYER CENTER
    OAKLAND, MD
    ZIP 21550
  • Facility Phone: 304 777-7467
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAYLOR CRABTREE
  • NPI Number: 1154197283
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2299754
LAB Type Physician Office
Facility Name HEADWATERS RESTORATION THERAPY
Street 4000 THAYER CENTER
City OAKLAND
State MD
ZIP 21550
Phone 304 777-7467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Physician Office
Lab Director TAYLOR CRABTREE

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This page was last updated on: 9/29/2025