Provider Demographics
NPI:1396573028
Name:MAIOLO, MEREDITH LEE (MT-BC)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LEE
Last Name:MAIOLO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7174
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-0174
Mailing Address - Country:US
Mailing Address - Phone:304-923-9861
Mailing Address - Fax:
Practice Address - Street 1:1936 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3110
Practice Address - Country:US
Practice Address - Phone:304-923-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13627225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist