Provider Demographics
NPI:1922287788
Name:CROSS, MEGAN (OTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-1414
Mailing Address - Country:US
Mailing Address - Phone:618-231-3464
Mailing Address - Fax:
Practice Address - Street 1:300 S HANCOCK ST
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-1414
Practice Address - Country:US
Practice Address - Phone:618-231-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant