Provider Demographics
NPI:1760117642
Name:SPICER, MEGAN SHANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SHANA
Last Name:SPICER
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 1:186 BUTLER RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-8055
Mailing Address - Country:US
Mailing Address - Phone:907-351-3261
Mailing Address - Fax:828-395-1470
Practice Address - Street 1:186 BUTLER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8055
Practice Address - Country:US
Practice Address - Phone:907-351-3261
Practice Address - Fax:828-395-1470
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant