Healthcare Provider Details

I. General information

NPI: 1184909350
Provider Name (Legal Business Name): PAIGE MARIE AUTUMN MEEK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAIGE MARIE AUTUMN WHITE LMT

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5577 N HIGH ST STE B
WORTHINGTON OH
43085-3939
US

IV. Provider business mailing address

7006 CHURCHILL DOWNS DR
NEW ALBANY OH
43054-8016
US

V. Phone/Fax

Practice location:
  • Phone: 614-400-4301
  • Fax: 513-823-4194
Mailing address:
  • Phone: 614-783-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number33.017440
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.017440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: