Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 02695 | MD |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 02695 | MD |
NPI | 1003380734 |
---|---|
Provider Name | Mrs. Kathy Ann Lueders |
First Address | Newark, MD 21841-2224 |
Second Address | Berlin, MD 21811-3250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2019 |
Last Update Date | 16/01/2019 |