1316088370 NPI number — MRS. TERESA PHYLLIS LEMERE M.S., OTR-L

Table of content: MRS. TERESA PHYLLIS LEMERE M.S., OTR-L (NPI 1316088370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316088370 NPI number — MRS. TERESA PHYLLIS LEMERE M.S., OTR-L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMERE
Provider First Name:
TERESA
Provider Middle Name:
PHYLLIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., OTR-L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEMERE
Provider Other First Name:
TERRI
Provider Other Middle Name:
PHYLLIS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., OTR-L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316088370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5686 SINGLETREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21703-8606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-694-6005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5686 SINGLETREE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-8606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-6005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  03639 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1016583 . This is a "NBCOT CERTIFICATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 03639 . This is a "OT LICENSE®ISTRATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 789R , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 971R , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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