MEDICARE: KRISTEN MEYER

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	235Z00000X	Speech-Language Pathologist	SP5195	OH

General Provider Information

NPI Number	:	1790109163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MEYER

Provider Business Mailing Address
First Line	:	11685 W STATE ROUTE 163
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-1278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11685 W STATE ROUTE 163
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-1278
Country	:	US
Telephone Number	:	419-898-6210
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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Directions to “ KRISTEN MEYER ” Practice Location

Language	Start Address	Practice Location

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