Provider Demographics
NPI:1154841708
Name:MEYER, ANDREA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 STATE ROUTE 705 W
Mailing Address - Street 2:
Mailing Address - City:FORT LORAMIE
Mailing Address - State:OH
Mailing Address - Zip Code:45845-9721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1624 STATE ROUTE 705 W
Practice Address - Street 2:
Practice Address - City:FORT LORAMIE
Practice Address - State:OH
Practice Address - Zip Code:45845-9721
Practice Address - Country:US
Practice Address - Phone:937-638-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer