Provider Demographics
NPI:1669853933
Name:WINGO, MEGAN NOVIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NOVIA
Last Name:WINGO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:NOVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:100 HORSEPEN WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4298
Mailing Address - Country:US
Mailing Address - Phone:864-616-7060
Mailing Address - Fax:
Practice Address - Street 1:100 HORSEPEN WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4298
Practice Address - Country:US
Practice Address - Phone:864-616-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOT.4518.OT225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics