Healthcare Provider Details

I. General information

NPI: 1093806739
Provider Name (Legal Business Name): KAREN LYNNE MEADE O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 7TH AVE
CUMBERLAND WI
54829-9138
US

IV. Provider business mailing address

1110 7TH AVE
CUMBERLAND WI
54829-9138
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-6167
  • Fax: 715-822-6142
Mailing address:
  • Phone: 715-822-6167
  • Fax: 715-822-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101250
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: