Provider Demographics
NPI:1447406798
Name:FOREMAN, MEREDITH K (LMT, MMP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:K
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CENTRAL LAFOURCHE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394
Mailing Address - Country:US
Mailing Address - Phone:985-532-6658
Mailing Address - Fax:
Practice Address - Street 1:114 CENTRAL LAFOURCHE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2543
Practice Address - Country:US
Practice Address - Phone:985-532-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist