Provider Demographics
NPI:1508202573
Name:BEWERNITZ, MEGAN RENAE WITTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENAE WITTE
Last Name:BEWERNITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENAE
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20400 SARATOGA LOS GATOS RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5927
Mailing Address - Country:US
Mailing Address - Phone:408-741-4930
Mailing Address - Fax:408-741-4930
Practice Address - Street 1:20400 SARATOGA LOS GATOS RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5927
Practice Address - Country:US
Practice Address - Phone:408-741-4930
Practice Address - Fax:408-741-4930
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist