Healthcare Provider Details

I. General information

NPI: 1851868236
Provider Name (Legal Business Name): DR LAURIE MECHAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15480 CLAYTON RD STE 103
BALLWIN MO
63011-3172
US

IV. Provider business mailing address

1470 SAINT PAUL RD
BALLWIN MO
63021-8210
US

V. Phone/Fax

Practice location:
  • Phone: 314-288-9525
  • Fax:
Mailing address:
  • Phone: 314-288-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY LAURIE MECHAM
Title or Position: OWNER
Credential: L.AC
Phone: 314-288-9525