Provider Demographics
NPI:1568936128
Name:TATTITCH, MEGAN J
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:J
Last Name:TATTITCH
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 1:385 W VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1066
Mailing Address - Country:US
Mailing Address - Phone:636-456-4311
Mailing Address - Fax:
Practice Address - Street 1:385 W VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1066
Practice Address - Country:US
Practice Address - Phone:636-456-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist