Healthcare Provider Details

I. General information

NPI: 1144762063
Provider Name (Legal Business Name): JODI MEKEEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DILL STREET
AUBURN NY
13021
US

IV. Provider business mailing address

8 DILL ST
AUBURN NY
13021-3606
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-1414
  • Fax:
Mailing address:
  • Phone: 315-253-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number868626355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: