Provider Demographics
NPI:1780020362
Name:MATHIS, MEGAN LYNN (BS, MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LYNN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:BS, MOT, OTR/L
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:1165 N GUIGNARD DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1516
Mailing Address - Country:US
Mailing Address - Phone:803-778-2724
Mailing Address - Fax:
Practice Address - Street 1:1165 N GUIGNARD DR
Practice Address - Street 2:SUITE 8
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1516
Practice Address - Country:US
Practice Address - Phone:803-778-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3552225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics