Provider Demographics
NPI:1629343173
Name:SOCCI, MEGAN ALICE (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ALICE
Last Name:SOCCI
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 1:3040 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5111
Mailing Address - Country:US
Mailing Address - Phone:718-822-5351
Mailing Address - Fax:
Practice Address - Street 1:3040 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5111
Practice Address - Country:US
Practice Address - Phone:718-822-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist