1568953222 NPI number — KELLI LEIGH MEYER MS, LAT, ATC

Table of content: KELLI LEIGH MEYER MS, LAT, ATC (NPI 1568953222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568953222 NPI number — KELLI LEIGH MEYER MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
KELLI
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
KELLI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568953222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 KINGSON LN UNIT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDWAY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02053-6150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 KINGSON LN UNIT 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDWAY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02053-6150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-612-2059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2213 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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