Provider Demographics
NPI:1851767313
Name:LEWANDOWSKI, MEREDITH (OT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:LEWANDOWSKI
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 1:312 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4126
Mailing Address - Country:US
Mailing Address - Phone:248-298-6296
Mailing Address - Fax:
Practice Address - Street 1:312 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4126
Practice Address - Country:US
Practice Address - Phone:248-298-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007874172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker