Provider Demographics
NPI:1639415201
Name:ELDER-DWIGHT, MEGAN CLAIRE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:CLAIRE
Last Name:ELDER-DWIGHT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CLAIRE
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3018 BLUE SHORES WAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-2447
Mailing Address - Country:US
Mailing Address - Phone:407-925-5623
Mailing Address - Fax:
Practice Address - Street 1:2639 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4878
Practice Address - Country:US
Practice Address - Phone:407-925-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCOTA/L 9828224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant