Healthcare Provider Details

I. General information

NPI: 1396623419
Provider Name (Legal Business Name): MERIDIAN A STOWERS OTD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST
KOKOMO IN
46901-5148
US

IV. Provider business mailing address

1609 BETHEL AVE
TIPTON IN
46072-9200
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-5611
  • Fax:
Mailing address:
  • Phone: 765-415-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008811A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: