Basic Information
| Provider Information | |||||||||
| NPI: | 1942466834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAUGHAN | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | |||||||||
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| Credential: | OTR,CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 ADAMS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926264865 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 ADAMS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926264865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145562288 | ||||||||
| FaxNumber: | 7144351745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 1791 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 1791 | 01 | CA | CALIFORNIA BOARD LICENSE | OTHER |