Provider Demographics
NPI:1245754811
Name:RIEDEL, MERIDETH (COTA)
Entity Type:Individual
Prefix:
First Name:MERIDETH
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MERIDETH
Other - Middle Name:
Other - Last Name:BLADES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 SW COUNTY ROAD 1005
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-8612
Mailing Address - Country:US
Mailing Address - Phone:903-229-3657
Mailing Address - Fax:
Practice Address - Street 1:3301 W PARK ROW BLVD
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4846
Practice Address - Country:US
Practice Address - Phone:903-872-2455
Practice Address - Fax:903-874-7286
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214475224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant