Provider Demographics
NPI:1275034704
Name:MEADOR, JACKI JEAN
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:JEAN
Last Name:MEADOR
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 1:6830 W 121ST CT
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2021
Mailing Address - Country:US
Mailing Address - Phone:913-239-8777
Mailing Address - Fax:913-239-0268
Practice Address - Street 1:6830 W 121ST CT
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2021
Practice Address - Country:US
Practice Address - Phone:913-239-8777
Practice Address - Fax:913-239-0268
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205412224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant