Provider Demographics
NPI:1528675402
Name:REARDON-MEACH, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:REARDON-MEACH
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 1:1143 MAMBRINO RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3144
Mailing Address - Country:US
Mailing Address - Phone:419-265-5332
Mailing Address - Fax:
Practice Address - Street 1:1143 MAMBRINO RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3144
Practice Address - Country:US
Practice Address - Phone:419-265-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4810143251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4810143Medicaid