Provider Demographics
NPI:1750509394
Name:METTEE, MEREDITH L (OT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:METTEE
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 1:5513 INVERNESS PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-1434
Mailing Address - Country:US
Mailing Address - Phone:205-372-3236
Mailing Address - Fax:
Practice Address - Street 1:216 1ST ST S
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481
Practice Address - Country:US
Practice Address - Phone:205-375-9255
Practice Address - Fax:205-375-9245
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-07519OtherBCBS PROVIDER NUMBER
AL2174OtherOT LICENSURE