Provider Demographics
NPI:1083058655
Name:MYERS, MEGAN (MOT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SAND CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-3233
Mailing Address - Country:US
Mailing Address - Phone:207-432-6107
Mailing Address - Fax:
Practice Address - Street 1:5 DUNAWAY DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5143
Practice Address - Country:US
Practice Address - Phone:207-490-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist