Provider Demographics
NPI:1932440468
Name:LAUER, ROBIN (CFOM, LPED)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LAUER
Suffix:
Gender:F
Credentials:CFOM, LPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1900
Mailing Address - Country:US
Mailing Address - Phone:330-633-9807
Mailing Address - Fax:330-633-9480
Practice Address - Street 1:33 NORTH AVE STE 201
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1900
Practice Address - Country:US
Practice Address - Phone:330-633-9807
Practice Address - Fax:330-633-9480
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224900000X
OHLPED2183224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2002853Medicaid