Provider Demographics
NPI:1750840245
Name:EALY, MEGHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:EALY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GRAPEVINE TRL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5295
Mailing Address - Country:US
Mailing Address - Phone:919-356-2199
Mailing Address - Fax:
Practice Address - Street 1:1245 PARK AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4025
Practice Address - Country:US
Practice Address - Phone:252-492-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist