MEDICARE: SPICEY MEEKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	32001727A	IN

General Provider Information

NPI Number	:	1700332756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPICEY MEEKS

Provider Business Mailing Address
First Line	:	8440 LINCOLN AVE APT A
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-7213
Country	:	US
Telephone Number	:	812-664-1841
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 LINCOLN AVE APT A
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-7213
Country	:	US
Telephone Number	:	812-664-1841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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Directions to “ SPICEY MEEKS ” Practice Location

Language	Start Address	Practice Location

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