Provider Demographics
NPI:1649570789
Name:PANAGOPOULOS, MEGHAN SHELTON (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:SHELTON
Last Name:PANAGOPOULOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:JOY
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5000 RESEARCH CT STE 450
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6609
Mailing Address - Country:US
Mailing Address - Phone:770-205-5551
Mailing Address - Fax:
Practice Address - Street 1:5991 PARKWAY NORTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1343
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist