Provider Demographics
NPI:1306231790
Name:MEYER, THADDEUS FORD (COTA/L)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:FORD
Last Name:MEYER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 W FRONTIER ST
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-9084
Mailing Address - Country:US
Mailing Address - Phone:480-773-5383
Mailing Address - Fax:
Practice Address - Street 1:1265 W FRONTIER ST
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-9084
Practice Address - Country:US
Practice Address - Phone:480-773-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist