Provider Demographics
NPI:1922404755
Name:NEIDERMYER, AUBREY R
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:R
Last Name:NEIDERMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3934
Mailing Address - Country:US
Mailing Address - Phone:410-889-0727
Mailing Address - Fax:410-889-0729
Practice Address - Street 1:228 N CREEK BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9006
Practice Address - Country:US
Practice Address - Phone:410-889-0727
Practice Address - Fax:410-889-0729
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist