Provider Demographics
NPI:1093251522
Name:PATTERSON, MEGAL JR (COTA)
Entity Type:Individual
Prefix:
First Name:MEGAL
Middle Name:
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2816
Mailing Address - Country:US
Mailing Address - Phone:321-946-5697
Mailing Address - Fax:
Practice Address - Street 1:388 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2816
Practice Address - Country:US
Practice Address - Phone:321-946-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009179-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant