Provider Demographics
NPI:1497124804
Name:VALDIVIESO, MEGAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:VALDIVIESO
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 1:2726 ALEXANDER PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2233
Mailing Address - Country:US
Mailing Address - Phone:815-979-1811
Mailing Address - Fax:
Practice Address - Street 1:1000 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2601
Practice Address - Country:US
Practice Address - Phone:912-335-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist