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General NPI Number Information
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NPI Number | 1295273423
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Entity Type | Individual
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Provider Name | MARY MECKERT OTA
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Gender | Female
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 1050 CHINOE RD SUITE 350
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City | LEXINGTON
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State | KY
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Zip | 40502-6571
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Country | US
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Telephone | 859-317-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 543 PORT DR
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City | AVON
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State | IN
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Zip | 46123-1237
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Country | US
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Telephone | 812-499-1692
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32000636A
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License Number State | IN
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