Provider Demographics
NPI:1851462170
Name:DABOLS, MEGAN ELLEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELLEN
Last Name:DABOLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELLEN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2821 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3543
Mailing Address - Country:US
Mailing Address - Phone:414-763-9359
Mailing Address - Fax:
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3710-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist