Provider Demographics
NPI:1508100983
Name:MEYER, MINDY J
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:J
Last Name:MEYER
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 1:1280 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2238
Mailing Address - Country:US
Mailing Address - Phone:978-987-1311
Mailing Address - Fax:
Practice Address - Street 1:130 PARKER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1556
Practice Address - Country:US
Practice Address - Phone:978-688-5070
Practice Address - Fax:978-688-0712
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist