Provider Demographics
NPI:1528535374
Name:GOTH, MEGAN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:GOTH
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 1:91-1063 OANIANI ST UNIT 3E
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2615
Mailing Address - Country:US
Mailing Address - Phone:706-615-1630
Mailing Address - Fax:
Practice Address - Street 1:92-461 MAKAKILO DR
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1270
Practice Address - Country:US
Practice Address - Phone:808-529-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-1818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist