Provider Demographics
NPI:1083615306
Name:MAURER, GRETCHEN L (OT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:MAURER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W BUTE STREET
Mailing Address - Street 2:SUITE 810
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1405
Mailing Address - Country:US
Mailing Address - Phone:757-623-0814
Mailing Address - Fax:757-625-5893
Practice Address - Street 1:229 W BUTE ST
Practice Address - Street 2:SUITE 810
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1405
Practice Address - Country:US
Practice Address - Phone:757-623-0814
Practice Address - Fax:757-625-5893
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000329225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
670000006Medicare UPIN