Provider Demographics
NPI:1699221143
Name:PONCHEL, MEAGAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:PONCHEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 NEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-1056
Mailing Address - Country:US
Mailing Address - Phone:419-545-5022
Mailing Address - Fax:
Practice Address - Street 1:1510 S CONWELL AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9448
Practice Address - Country:US
Practice Address - Phone:419-964-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant