Provider Demographics
NPI:1710553847
Name:PLACIDE, MEADJEAN (OT)
Entity Type:Individual
Prefix:
First Name:MEADJEAN
Middle Name:
Last Name:PLACIDE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 STACEY DR APT 1610
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5925
Mailing Address - Country:US
Mailing Address - Phone:917-684-6010
Mailing Address - Fax:
Practice Address - Street 1:5055 STACEY DR APT 1610
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5925
Practice Address - Country:US
Practice Address - Phone:917-684-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist