Provider Demographics
NPI:1417373440
Name:ROY, MEGAN ANN (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:ROY
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SECOND LOOP RD
Mailing Address - Street 2:MCLEOD PEDIATRIC REHAB
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505
Mailing Address - Country:US
Mailing Address - Phone:843-777-4075
Mailing Address - Fax:843-777-4065
Practice Address - Street 1:440 SECOND LOOP RD
Practice Address - Street 2:MCLEOD PEDIATRIC REHAB
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:843-777-4075
Practice Address - Fax:843-777-4065
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.4263OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPO 334(MCLEODMedicaid