Provider Demographics
NPI:1609683978
Name:MEAD, MEREDITH R (MA61181340)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:R
Last Name:MEAD
Suffix:
Gender:F
Credentials:MA61181340
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1503
Mailing Address - Country:US
Mailing Address - Phone:509-662-2161
Mailing Address - Fax:
Practice Address - Street 1:416 9TH ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1503
Practice Address - Country:US
Practice Address - Phone:509-662-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61181340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist