Provider Demographics
NPI:1174910459
Name:WASSON, MEREDITH J (MED, ATC)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:J
Last Name:WASSON
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:J
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, ATC
Mailing Address - Street 1:6475 S YALE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7815
Mailing Address - Country:US
Mailing Address - Phone:918-494-9300
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:6475 S YALE AVE STE 301
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7815
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9355
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer