Provider Demographics
NPI:1568052280
Name:HAUSE, MEGAN ALEXANDRA (COTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALEXANDRA
Last Name:HAUSE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALEXANDRA
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:7107 LIBRARY BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:317-215-0239
Mailing Address - Fax:317-881-9966
Practice Address - Street 1:7101 LIBRARY BLVD
Practice Address - Street 2:STE. A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:317-215-0239
Practice Address - Fax:317-881-9966
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002083A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant