Provider Demographics
NPI:1467745372
Name:VASQUEZ, MEGAN BROOKE (MEGAN VASQUEZ)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MEGAN VASQUEZ
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BROOKE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2720 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7162
Mailing Address - Country:US
Mailing Address - Phone:903-641-1484
Mailing Address - Fax:
Practice Address - Street 1:2720 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7162
Practice Address - Country:US
Practice Address - Phone:903-641-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210964224Z00000X
KS1800734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant