Provider Demographics
NPI:1619698479
Name:MEYER, TERESA M
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3280
Mailing Address - Country:US
Mailing Address - Phone:513-284-8197
Mailing Address - Fax:
Practice Address - Street 1:1200 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1209
Practice Address - Country:US
Practice Address - Phone:513-733-3370
Practice Address - Fax:513-786-7893
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0038292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2255A2300XOtherATHLETIC TRAINER