Provider Demographics
NPI:1487012654
Name:MOENING, MEGAN MOCK (OT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MOCK
Last Name:MOENING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:J
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:5757 W THUNDERBIRD RD STE 465
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4650
Practice Address - Country:US
Practice Address - Phone:602-243-9945
Practice Address - Fax:602-843-8775
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.009180225X00000X
AZ7465225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist