Provider Demographics
NPI:1578701728
Name:WALSTON, MEGAN ANN (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ANN
Last Name:WALSTON
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OAKWOOD PLACE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2021
Mailing Address - Country:US
Mailing Address - Phone:518-439-3398
Mailing Address - Fax:518-439-1222
Practice Address - Street 1:18 OAKWOOD PLACE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2021
Practice Address - Country:US
Practice Address - Phone:518-439-3398
Practice Address - Fax:518-439-1222
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011223-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency