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General NPI Number Information
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NPI Number | 1518420819
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Entity Type | Individual
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Provider Name | LAWRENCE DUANE MORTEMORE
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Gender | Male
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 3241 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3311
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Country | US
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Telephone | 419-690-8267
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Fax | 419-690-8324
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Provider Business Mailing Address
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Address Line | 3241 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3311
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Country | US
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Telephone | 419-690-8267
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Fax | 419-690-8324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 02876
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License Number State | OH
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