Provider Demographics
NPI:1114791845
Name:DYSTER, MEGHAN NICHOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:NICHOLE
Last Name:DYSTER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2829
Mailing Address - Country:US
Mailing Address - Phone:913-708-2787
Mailing Address - Fax:
Practice Address - Street 1:11071 N WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-1552
Practice Address - Country:US
Practice Address - Phone:816-653-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030420225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist