Provider Demographics
NPI:1598275067
Name:AJA, MEREDITH (MOT)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:AJA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4257
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-4257
Mailing Address - Country:US
Mailing Address - Phone:231-342-2442
Mailing Address - Fax:
Practice Address - Street 1:1282 KIRTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4888
Practice Address - Country:US
Practice Address - Phone:248-918-5560
Practice Address - Fax:248-918-5565
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009972225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand