Provider Demographics
NPI:1710125281
Name:SMITH, MEAGAN L (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:L
Other - Last Name:LUDLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9117 OLD WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9590
Mailing Address - Country:US
Mailing Address - Phone:228-217-7717
Mailing Address - Fax:228-875-0767
Practice Address - Street 1:9117 OLD WALNUT RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-9590
Practice Address - Country:US
Practice Address - Phone:228-217-7717
Practice Address - Fax:228-875-0767
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1703225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06374509Medicaid