Provider Demographics
NPI:1003380734
Name:LUEDERS, KATHY ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:LUEDERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 WORCESTER HWY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:MD
Mailing Address - Zip Code:21841-2224
Mailing Address - Country:US
Mailing Address - Phone:443-632-5000
Mailing Address - Fax:
Practice Address - Street 1:11318 SHOWELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3250
Practice Address - Country:US
Practice Address - Phone:410-632-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02695225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist