Provider Demographics
NPI:1316165483
Name:MEISSNER, BEVERLY JO (LD)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JO
Last Name:MEISSNER
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-8921
Mailing Address - Country:US
Mailing Address - Phone:253-431-7171
Mailing Address - Fax:
Practice Address - Street 1:330 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5007
Practice Address - Country:US
Practice Address - Phone:253-931-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter