Provider Demographics
NPI:1538378831
Name:LAYDEVANT, MERI (OTR)
Entity type:Individual
Prefix:MS
First Name:MERI
Middle Name:
Last Name:LAYDEVANT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2039
Mailing Address - Country:US
Mailing Address - Phone:936-709-2560
Mailing Address - Fax:
Practice Address - Street 1:3205 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2039
Practice Address - Country:US
Practice Address - Phone:936-709-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111576OtherOCCUPATIONAL THERAPY