Provider Demographics
NPI:1003677162
Name:BROCKUNIER, MEGHAN MARY (OTR)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARY
Last Name:BROCKUNIER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 SCARLET OAK CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4735
Mailing Address - Country:US
Mailing Address - Phone:845-545-2898
Mailing Address - Fax:
Practice Address - Street 1:1308 SCARLET OAK CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-4735
Practice Address - Country:US
Practice Address - Phone:845-545-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist