Provider Demographics
NPI:1508356494
Name:MCCLOSKEY, MEGHAN LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LYNN
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16119 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-9175
Mailing Address - Country:US
Mailing Address - Phone:316-218-7838
Mailing Address - Fax:
Practice Address - Street 1:560 N EXPOSITION ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5902
Practice Address - Country:US
Practice Address - Phone:316-618-1252
Practice Address - Fax:316-869-2277
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01498224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant