Healthcare Provider Details

I. General information

NPI: 1326563503
Provider Name (Legal Business Name): AUDREY LANE DOELLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 RIDGEBROOK RD STE 310
SPARKS GLENCOE MD
21152-9440
US

IV. Provider business mailing address

1116 WISEBURG RD
WHITE HALL MD
21161-9402
US

V. Phone/Fax

Practice location:
  • Phone: 443-212-5745
  • Fax:
Mailing address:
  • Phone: 443-841-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08460
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: