Provider Demographics
NPI:1093403370
Name:BADU-YEBOAH, MEGAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BADU-YEBOAH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 VENITIA REAL AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-4011
Mailing Address - Country:US
Mailing Address - Phone:202-394-4036
Mailing Address - Fax:
Practice Address - Street 1:10307 VENITIA REAL AVE APT 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-4011
Practice Address - Country:US
Practice Address - Phone:202-394-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19449224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant