Provider Demographics
NPI:1669543385
Name:MEINHARD, KATRINA LYNN (PT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:MEINHARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LYNN
Other - Last Name:MCCUMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 BARCLAY CIR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5815
Mailing Address - Country:US
Mailing Address - Phone:586-991-0801
Mailing Address - Fax:586-991-0804
Practice Address - Street 1:245 BARCLAY CIR
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5815
Practice Address - Country:US
Practice Address - Phone:586-991-0801
Practice Address - Fax:586-991-0804
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383683108OtherCOMMERCIAL
MI383683108OtherCOMMERCIAL