Provider Demographics
NPI:1841425063
Name:WITTENBERG, MEGAN LEIGH (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEIGH
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 CAMACK TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4328
Mailing Address - Country:US
Mailing Address - Phone:330-322-0212
Mailing Address - Fax:
Practice Address - Street 1:14318 CAMACK TRL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4328
Practice Address - Country:US
Practice Address - Phone:330-322-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841425063OtherNPI