Basic Information
| Provider Information | |||||||||
| NPI: | 1245754811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIEDEL | ||||||||
| FirstName: | MERIDETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | COTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BLADES | ||||||||
| OtherFirstName: | MERIDETH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 SW COUNTY ROAD 1005 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751108612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032293657 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3301 W PARK ROW BLVD | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751104846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038722455 | ||||||||
| FaxNumber: | 9038747286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 214475 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.