Provider Demographics
NPI:1740617885
Name:LILLY, MEAGAN LOUISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LOUISE
Last Name:LILLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:LOUISE
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9317 W CREOSOTE RAIN DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-1010
Mailing Address - Country:US
Mailing Address - Phone:858-472-2789
Mailing Address - Fax:
Practice Address - Street 1:5250 W DOVE CENTRE RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-5159
Practice Address - Country:US
Practice Address - Phone:520-232-2483
Practice Address - Fax:520-844-7827
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13844225X00000X
AZOTH-008341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist