Provider Demographics
NPI:1477046100
Name:REEVES, MEGAN LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:REEVES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 N GOLDENROD RD APT D
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9179
Mailing Address - Country:US
Mailing Address - Phone:901-481-3124
Mailing Address - Fax:
Practice Address - Street 1:7200 LAKE ELLENOR DR STE 146
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6254
Practice Address - Country:US
Practice Address - Phone:321-236-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA16533OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE