Provider Demographics
NPI:1518420819
Name:MORTEMORE, LAWRENCE DUANE
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DUANE
Last Name:MORTEMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3311
Mailing Address - Country:US
Mailing Address - Phone:419-690-8267
Mailing Address - Fax:419-690-8324
Practice Address - Street 1:3241 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3311
Practice Address - Country:US
Practice Address - Phone:419-690-8267
Practice Address - Fax:419-690-8324
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02876237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter