Provider Demographics
NPI:1124791306
Name:MEYER, KATHY RAE
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:RAE
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 1:10715 VANDERVOORT RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-9426
Mailing Address - Country:US
Mailing Address - Phone:513-544-2296
Mailing Address - Fax:
Practice Address - Street 1:10715 VANDERVOORT RD
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-9426
Practice Address - Country:US
Practice Address - Phone:513-544-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant