Provider Demographics
NPI:1831674241
Name:CLARK, MEGAN (OTR/L, CNT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR/L, CNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 GORMEL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3121
Mailing Address - Country:US
Mailing Address - Phone:703-434-2316
Mailing Address - Fax:
Practice Address - Street 1:7130 GORMEL DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3121
Practice Address - Country:US
Practice Address - Phone:703-434-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010001159225XP0019X
VA0119005898225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119005898OtherOT LICENSE VA
DCOT010001159OtherOT LICENSE DC