Healthcare Provider Details

I. General information

NPI: 1235615519
Provider Name (Legal Business Name): MEREDITH CARPENTER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 OLD ROUTE 66
SAINT ROBERT MO
65584-3727
US

IV. Provider business mailing address

60 FORREST ST
FORT LEONARD WOOD MO
65473-1236
US

V. Phone/Fax

Practice location:
  • Phone: 573-434-6699
  • Fax:
Mailing address:
  • Phone: 330-687-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2018025073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: