Provider Demographics
NPI:1497902845
Name:LEROUX, MAUDE C
Entity Type:Individual
Prefix:MRS
First Name:MAUDE
Middle Name:C
Last Name:LEROUX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MAUDE
Other - Middle Name:C
Other - Last Name:LEROUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9 LACRUE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1062
Mailing Address - Country:US
Mailing Address - Phone:484-840-1529
Mailing Address - Fax:484-840-1560
Practice Address - Street 1:9 LACRUE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1062
Practice Address - Country:US
Practice Address - Phone:484-840-1529
Practice Address - Fax:484-840-1560
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006328L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist