Healthcare Provider Details

I. General information

NPI: 1306838347
Provider Name (Legal Business Name): MERAE L WHITMYER O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5047 DUNSHA RD
MEDINA OH
44256-8483
US

IV. Provider business mailing address

5047 DUNSHA RD
MEDINA OH
44256-8483
US

V. Phone/Fax

Practice location:
  • Phone: 330-239-4491
  • Fax: 330-239-4490
Mailing address:
  • Phone: 330-239-4491
  • Fax: 330-239-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number03111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: