MEDICARE: MR. RALPH WALTER MECKSTROTH IV OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-2794	NV

General Provider Information

NPI Number	:	1255005971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH WALTER MECKSTROTH IV OTR/L

Provider Business Mailing Address
First Line	:	2599 RITTENHOUSE RD
Second Line	:
City	:	NORTH BEND
State	:	OH
Zip	:	45052-9719
Country	:	US
Telephone Number	:	513-262-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	2599 RITTENHOUSE RD
Second Line	:
City	:	NORTH BEND
State	:	OH
Zip	:	45052-9719
Country	:	US
Telephone Number	:	513-262-7659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	06/13/2023

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