Provider Demographics
NPI:1992730386
Name:MECHAM, JAMES P (MS, OTRIL)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:MECHAM
Suffix:
Gender:M
Credentials:MS, OTRIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 30TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1939
Mailing Address - Country:US
Mailing Address - Phone:866-470-4440
Mailing Address - Fax:866-520-5557
Practice Address - Street 1:3921 30TH AVE STE A
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1939
Practice Address - Country:US
Practice Address - Phone:866-470-4440
Practice Address - Fax:866-520-5557
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006853225X00000X
WI2814026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40857000Medicaid
ILK16595Medicare ID - Type Unspecified
WI40857000Medicaid