Provider Demographics
NPI:1437655495
Name:BECK, MEGAN ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ANN
Last Name:BECK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:GONVICK
Mailing Address - State:MN
Mailing Address - Zip Code:56644-4185
Mailing Address - Country:US
Mailing Address - Phone:507-420-0630
Mailing Address - Fax:
Practice Address - Street 1:1656 CENTRAL ST W
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-4357
Practice Address - Country:US
Practice Address - Phone:218-694-8047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist