Provider Demographics
NPI:1710432505
Name:GAYDOSH, MEGAN (OT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GAYDOSH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CHURCH ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3792
Mailing Address - Country:US
Mailing Address - Phone:843-520-8810
Mailing Address - Fax:843-545-5310
Practice Address - Street 1:407 CHURCH ST UNIT E
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3792
Practice Address - Country:US
Practice Address - Phone:843-520-8810
Practice Address - Fax:843-545-5310
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist