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NPI Code Detail

MEDICARE: MEREDITH CELESTE SIMON CMT

MEDICARE: MEREDITH CELESTE SIMON CMT
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
1225700000XMassage Therapist1386CA

General Provider Information

NPI Number : 1700587250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH CELESTE SIMON CMT
Provider Business Mailing Address
First Line : 6114 MARTIN LUTHER KING JR WAY
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1241
Country : US
Telephone Number : 845-249-8469
Fax Number :
Provider Business Practice Location Address
First Line : 1211 EMBARCADERO STE D
Second Line :
City : OAKLAND
State : CA
Zip : 94606-5117
Country : US
Telephone Number : 845-249-8469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2023
Last Update Date : 03/13/2023

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