Provider Demographics
NPI:1558566497
Name:MEYER, GEORGIA E (OTR)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:E
Last Name:MEYER
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:REHAB IN MOTION
Mailing Address - Street 2:615 EAST MAIN ST SUITE B
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094
Mailing Address - Country:US
Mailing Address - Phone:920-262-9970
Mailing Address - Fax:920-262-9930
Practice Address - Street 1:RAHAB IN MOTION
Practice Address - Street 2:615 EAST MAIN ST SUITE B
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-262-9970
Practice Address - Fax:920-262-9950
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2128 026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41813900Medicaid
WI41813900Medicaid