MEDICARE: KOURTNEY BROOKE MEINHARDT

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1366076929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOURTNEY BROOKE MEINHARDT

Provider Business Mailing Address
First Line	:	18699 COUNTY ROAD 249
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-2138
Country	:	US
Telephone Number	:	660-342-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S JOHNSON ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1657
Country	:	US
Telephone Number	:	660-342-8351
Fax Number	:

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

Provider Enumeration Date	:	02/23/2020
Last Update Date	:	10/13/2023

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