Provider Demographics
NPI:1609934686
Name:MEYER, OTTO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-6456
Mailing Address - Country:US
Mailing Address - Phone:813-892-2498
Mailing Address - Fax:
Practice Address - Street 1:8414 TUPELO DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-6456
Practice Address - Country:US
Practice Address - Phone:813-892-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist