Provider Demographics
NPI:1568517423
Name:MEALOR, LORI WHEELER (OT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:WHEELER
Last Name:MEALOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 OAKCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1329
Mailing Address - Country:US
Mailing Address - Phone:478-755-9549
Mailing Address - Fax:
Practice Address - Street 1:1133 OAKCLIFF RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1329
Practice Address - Country:US
Practice Address - Phone:478-755-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00716042BMedicaid