Provider Demographics
NPI:1295069235
Name:MERIDITH, DEBORAH E (LRT/CTRS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:MERIDITH
Suffix:
Gender:F
Credentials:LRT/CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6657 KIMESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-9108
Mailing Address - Country:US
Mailing Address - Phone:336-565-9723
Mailing Address - Fax:336-565-0644
Practice Address - Street 1:6657 KIMESVILLE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-9108
Practice Address - Country:US
Practice Address - Phone:336-565-9723
Practice Address - Fax:336-565-0644
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist