Provider Demographics
NPI:1780179499
Name:MINGLE, MEAGAN NICHOLE (OTR)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICHOLE
Last Name:MINGLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 UNITED KINGDOM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6411
Mailing Address - Country:US
Mailing Address - Phone:832-877-1500
Mailing Address - Fax:
Practice Address - Street 1:8803 UNITED KINGDOM DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6411
Practice Address - Country:US
Practice Address - Phone:832-877-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113334225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics