Provider Demographics
NPI:1225400377
Name:MARTIN, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2317
Mailing Address - Country:US
Mailing Address - Phone:732-910-9196
Mailing Address - Fax:
Practice Address - Street 1:508 10TH AVE
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2317
Practice Address - Country:US
Practice Address - Phone:732-910-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00579200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist