=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245268259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL A MEYERS OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 DELAWARE ST SE UNIVERSITY OF MINNESOTA PHYSICIANS
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55455-0341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-626-6688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 DELAWARE ST SE DEPT M UNIVERSITY OF MINNESOTA PHYSICIANS
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55455-0374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-626-6688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 100423
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------