Healthcare Provider Details

I. General information

NPI: 1306050885
Provider Name (Legal Business Name): KATHLEEN MARY MEADE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GREAT BARRINGTON RD
WEST STOCKBRIDGE MA
01266-9216
US

IV. Provider business mailing address

107 GREAT BARRINGTON RD
WEST STOCKBRIDGE MA
01266-9216
US

V. Phone/Fax

Practice location:
  • Phone: 413-717-5864
  • Fax:
Mailing address:
  • Phone: 413-717-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: