Provider Demographics
NPI:1639769219
Name:POULSEN, MEGAN WALKER (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:WALKER
Last Name:POULSEN
Suffix:
Gender:F
Credentials: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:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-3171
Mailing Address - Fax:775-726-3797
Practice Address - Street 1:700 N. SPRING STREET
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008-1010
Practice Address - Country:US
Practice Address - Phone:775-726-3171
Practice Address - Fax:775-726-3797
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist