Healthcare Provider Details

I. General information

NPI: 1750509394
Provider Name (Legal Business Name): MEREDITH L METTEE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 1ST ST S
REFORM AL
35481
US

IV. Provider business mailing address

5513 INVERNESS PL
NORTHPORT AL
35473-1434
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-9255
  • Fax: 205-375-9245
Mailing address:
  • Phone: 205-372-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2174
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: