Provider Demographics
NPI:1366076929
Name:MEINHARDT, KOURTNEY BROOKE
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:BROOKE
Last Name:MEINHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18699 COUNTY ROAD 249
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-2138
Mailing Address - Country:US
Mailing Address - Phone:660-342-8351
Mailing Address - Fax:
Practice Address - Street 1:120 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-1657
Practice Address - Country:US
Practice Address - Phone:660-342-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant