Provider Demographics
NPI:1720420771
Name:MEYER, MARY E
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 BLACKBEARD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE TORCH KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-5507
Mailing Address - Country:US
Mailing Address - Phone:321-262-1445
Mailing Address - Fax:
Practice Address - Street 1:3227 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2423
Practice Address - Country:US
Practice Address - Phone:321-262-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14746225X00000X
MD07193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist