Provider Demographics
NPI:1508434523
Name:RODMAN, MEGAN LYNN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:RODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15512 AYDEN ST
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-8751
Mailing Address - Country:US
Mailing Address - Phone:660-342-4373
Mailing Address - Fax:
Practice Address - Street 1:15512 AYDEN ST
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-8751
Practice Address - Country:US
Practice Address - Phone:660-342-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
MO2021019022224Z00000X
KS18-01827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant