Healthcare Provider Details

I. General information

NPI: 1669543245
Provider Name (Legal Business Name): LUCY M MOHR C.PED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ROBIN HOOD TRL
OCEAN PINES MD
21811-1687
US

IV. Provider business mailing address

104 ROBIN HOOD TRL
OCEAN PINES MD
21811-1687
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-6400
  • Fax:
Mailing address:
  • Phone: 410-641-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCPED0653
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: