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General NPI Number Information
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NPI Number | 1851868236
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Entity Type | Organization
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Legal Business Name | DR LAURIE MECHAM PC
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 15480 CLAYTON RD STE 103
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City | BALLWIN
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State | MO
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Zip | 63011-3172
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Country | US
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Telephone | 314-288-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 SAINT PAUL RD
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City | BALLWIN
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State | MO
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Zip | 63021-8210
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Country | US
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Telephone | 314-288-9525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY LAURIE MECHAM
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Credential | L.AC
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Telephone | 314-288-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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