Provider Demographics
NPI:1992057806
Name:THIBO, MEREDITH JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JEAN
Last Name:THIBO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1323
Mailing Address - Country:US
Mailing Address - Phone:253-365-5750
Mailing Address - Fax:
Practice Address - Street 1:1507 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1323
Practice Address - Country:US
Practice Address - Phone:253-365-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist