Provider Demographics
NPI:1912324195
Name:MOHRBACHER, ERIC (OT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MOHRBACHER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2170
Mailing Address - Country:US
Mailing Address - Phone:541-269-7212
Mailing Address - Fax:541-267-5260
Practice Address - Street 1:1650 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2170
Practice Address - Country:US
Practice Address - Phone:541-269-7212
Practice Address - Fax:541-267-5260
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR323723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist