Provider Demographics
NPI:1215246855
Name:MACE, MEGHAN ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANN
Last Name:MACE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ANN
Other - Last Name:MESHINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16176 SAWMILL CT
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-926-0909
Practice Address - Fax:248-624-3332
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist