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General NPI Number Information
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NPI Number | 1184051609
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Entity Type | Individual
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Provider Name | MEREDITH ROXANNE CRISP MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/29/2013
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 18380 PANTHER TRAIL LN
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City | N FORT MYERS
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State | FL
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Zip | 33917-4728
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Country | US
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Telephone | 239-565-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 18380 PANTHER TRAIL LN
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City | N FORT MYERS
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State | FL
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Zip | 33917-4728
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Country | US
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Telephone | 239-565-6857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 15987
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License Number State | FL
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