Provider Demographics
NPI:1598212201
Name:TAYLOR-MEZA, ALICEA EMILY (ATC)
Entity Type:Individual
Prefix:
First Name:ALICEA
Middle Name:EMILY
Last Name:TAYLOR-MEZA
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 1:3602 N WASHINGTON ST
Mailing Address - Street 2:APT F29
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075
Mailing Address - Country:US
Mailing Address - Phone:915-246-4150
Mailing Address - Fax:
Practice Address - Street 1:200 ATHLETIC CENTER
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-4635
Practice Address - Country:US
Practice Address - Phone:915-246-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer