Provider Demographics
NPI:1922149715
Name:EHLERS, MARY R (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:EHLERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7421
Mailing Address - Country:US
Mailing Address - Phone:541-734-2263
Mailing Address - Fax:
Practice Address - Street 1:1050 CRATER LAKE AVE STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6223
Practice Address - Country:US
Practice Address - Phone:541-890-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist