Provider Demographics
NPI:1295030427
Name:MEADOWS, CHARLEY (OTR)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 S CLACK ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1557
Mailing Address - Country:US
Mailing Address - Phone:325-690-5131
Mailing Address - Fax:325-690-5228
Practice Address - Street 1:765 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5011
Practice Address - Country:US
Practice Address - Phone:325-690-5131
Practice Address - Fax:325-690-5228
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist