MEDICARE: MRS. CARLY VICTORIA MEACHAM MS, 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	015799-1	NY

General Provider Information

NPI Number	:	1689904393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLY VICTORIA MEACHAM MS, OTR/L

Provider Business Mailing Address
First Line	:	8020 HARRISBURG HOLLOW RD
Second Line	:
City	:	BATH
State	:	NY
Zip	:	14810-8258
Country	:	US
Telephone Number	:	607-382-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	3942 PINE HILL RD
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-9782
Country	:	US
Telephone Number	:	607-382-1426
Fax Number	:

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

Provider Enumeration Date	:	12/31/2009
Last Update Date	:	06/20/2013

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