Individual
MARY A MEISMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CHT (NBCOT)
Contact information
Practice address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Mailing address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056000370
IL
225XH1200X
Hand Occupational Therapist
Primary
056000370
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056.000370
STATE LICENSE
IL
Enumeration date
08/03/2006
Last updated
01/04/2017
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