Provider Demographics
NPI:1396196374
Name:JOLY, MEREDYTH (ATC)
Entity Type:Individual
Prefix:
First Name:MEREDYTH
Middle Name:
Last Name:JOLY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROSS HILL ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-2920
Mailing Address - Country:US
Mailing Address - Phone:860-334-2310
Mailing Address - Fax:
Practice Address - Street 1:18 ROSS HILL ROAD EXT
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-2920
Practice Address - Country:US
Practice Address - Phone:860-334-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer