Provider Demographics
NPI:1013491414
Name:EHRET, JUDITH ANN (OT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:EHRET
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5826 LITTLELEAF CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6356
Mailing Address - Country:US
Mailing Address - Phone:301-865-5826
Mailing Address - Fax:
Practice Address - Street 1:4101 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4115
Practice Address - Country:US
Practice Address - Phone:301-829-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist