Provider Demographics
NPI:1679711980
Name:MEACHAM, VANESSA R (PT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SOUTH 30TH
Mailing Address - Street 2:BOX 86
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0086
Mailing Address - Country:US
Mailing Address - Phone:580-323-8778
Mailing Address - Fax:580-323-8743
Practice Address - Street 1:509 SOUTH 30TH
Practice Address - Street 2:BOX 86
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-0086
Practice Address - Country:US
Practice Address - Phone:580-323-8778
Practice Address - Fax:580-323-8743
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist